Awareness of Genitourinary Cancers Risk Factors—A 2024 Population-Based Cross-Sectional Study in Poland

ObjectiveThis study aimed to assess the awareness of genitourinary cancers risk factors among adults in Poland and to identify factors associated with public awareness of risk factors for genitourinary cancers.MethodsThis cross-sectional survey was carried out between 1 and 4 March 2024 in a nationwide sample of 2,165 adults in Poland. Quota sampling was used. Data were collected using computer-assisted web interview (CAWI) method.ResultsRegardless of the type of cancer (kidney, bladder, or prostate cancer), a family history of cancer was the most recognized risk factor indicated by over half of respondents. Over one-third were aware that chemical exposure increases the risk for bladder cancer (39.4%) or prostate cancer (34.2%). Smoking was recognized as a risk factor for kidney cancer by 40.6% of respondents. Female gender, having higher education, being occupationally active and the presence of chronic diseases were the most important factors (p < 0.05) associated with a higher level of awareness of genitourinary cancers risk factors.ConclusionThis study revealed gaps in public awareness of genitourinary cancers risk factors among adults in Poland, especially lifestyle-related and workplace-related risk factors

Effects of the evolving global tobacco product landscape on smokers' switching behaviors

How effectively governments can use tobacco tax as a public health and a revenue-generating measure depends on how able smokers are to circumvent the tax by switching to other tobacco products. Recently, tobacco product switching has become more common, especially with many new tobacco product types appearing on the market. The research on these switching behaviors is scarce. This thesis provides analysis in three aspects tobacco product switching: (1) price-driven between-product substitution, (2) switching to newly-introduced tobacco products and (3) switching to products on which no domestic tax has been paid. When the ratio of tobacco product prices changes, consumers sometimes choose to switch between products. Zambia, with a high prevalence of roll-your-own (RYO) tobacco, a less costly alternative to factory-made (FM) cigarettes, is a case in point. The study presented in the second chapter of this thesis used individual-level data obtained from the 2012 and 2014 waves of the ITC Zambia Survey to model the probability of FM and RYO cigarette smoking, as well as between-product substitution. It found that increasing the cigarette tax, with corresponding price increases, could significantly reduce cigarette use in Zambia. Furthermore, reducing between-product price differences would reduce substitution from FM to RYO. With the proliferation of many new tobacco product types, traditional cigarettes are becoming less dominant. With the introduction of a new product to the market, between-product switching might not be influenced purely by price differences across product types, but rather driven by the increased variety of products on the market. Chapter three makes use of a natural experiment created during the rollout of a heated tobacco product, IQOS, in 2015 and 2016 in Japan to examine if trends in cigarette sales have changed with the introduction of IQOS in each region. A series of placebo models are estimated to test if events other than IQOS introduction could have better explained trends in cigarette sales. The results show that the introduction of IQOS likely reduced cigarette sales in Japan. Large differences in cigarette prices observed between geographical regions might incentivize some smokers from regions with higher cigarette prices to switch to cheaper cigarettes available across the border. The fourth chapter uses 2004-2017 official European Commission data and a methodology developed by Becker (1990), to analyze the association between prices and crossborder cigarette purchases in the European Union. Incentives for cross-border purchasing are measured as a function of differences in cigarette prices between bordering countries, controlling for population density near borders and for gasoline prices. The scale of cross-border cigarette purchasing in the EU is small, and not-significant through maritime borders. An upward convergence of cigarette prices across EU Member States would further reduce the cross-border purchasing problem

Nurse-led lifestyle counseling in Polish primary care: the effect of current health status and perceived barriers

IntroductionOur study included counseling on diet and physical activity, smoking, e-cigarette use, and alcohol consumption. The aim was to examine the correlates of counseling provided by primary care nurses with the health status/health behaviors of nurses and the barriers in the advice provided.Materials and methodsIn 2022, we conducted a cross-sectional survey among 331 nurses employed in the primary care sector in Lodz. The questionnaire consisted of three sections: characteristics of the patient population receiving treatment and provided with healthy lifestyle counseling by nurses, barriers to the process of assessing, controlling, and guiding patients, and health status/health behaviors of nurses.ResultsEighty percent of the nurses in our study provided advice on diet and physical activity to primary care patients. Over 70% of the survey participants performed minimal anti-smoking interventions forsmokers, 67.7% for alcohol drinkers, and 56.8% for e-cigarette users. The correlates of counseling in the field of diet and physical activity turned out to be the knowledge and skills, which enabled nurses to provide advice (OR = 2.57, p < 0.01). The correlates of the conducted minimal anti-smoking interventions in smoking patients were: subjective assessment of overweight and obesity in nurses, knowledge and skills in conducting counseling (OR = 1.92, p < 0.05), and measuring body weight, height and BMI (OR = 2.18, p < 0.01). Among the three most common barriers identified by the nurses in the process of assessing, monitoring, and guiding patients were the opinion that patients are not interested in improving their diet, physical activity, and weight loss (60.7%), lack of time (51.4%), as well as the belief that patients find it too difficult to change their current habits (54.1%).ConclusionThe results of our survey indicate that nurses’ participation in healthy lifestyle counseling in adult patients is unsatisfactory. Interventions in primary care should be designed considering the specific obstacles nurses may face in leading healthy lifestyles. Further training of nursing staff is required to increase their knowledge on healthy lifestyles

Electronic Cigarette Marketing: Current Research and Policy

This report outlines results from three separate but connected pieces of research. First, a review of the current e-cigarette market drawing on available data from market analysis, the trade press and other published sources. Secondly, a systematic rapid review of the e-cigarette marketing literature published in peer reviewed journals between 2011 and 2016, updating our previous work in this area. Finally, a description of the past and current regulatory framework for e-cigarette marketing in the UK, drawing on semi-structured interviews with key professionals working in the field and relevant documentary sources

Contributing to smoke-free:How can the provision and uptake of smoking cessation support be improved, including for those with mental health conditions?

Background:Smoking tobacco cigarettes is a major risk factor for cancer, chronic obstructive pulmonary disease (COPD), stroke, and heart disease. Although the United Kingdom (UK) has a comprehensive tobacco control strategy and adult smoking prevalence has reduced considerably over the past decades, from 45% in 1974 to 12.9% in 2022, smoking is still a leading preventable cause of illness and premature death in the UK and worldwide. Additionally, there are significant disparities in smoking prevalence within the population. For example, smoking prevalence is significantly higher in those with mental health conditions compared to those without, and depression and anxiety are two of the most common mental health conditions among people who smoke. Research is needed to explore how further reductions in population-level smoking prevalence can be made, including in those with mental health conditions, in order to reach national “smoke-free” or “tobacco end game” ambitions for all, which are typically defined as ≤5% adult smoking prevalence.Aim and Objectives:Aim: Contribute to the evidence base regarding how the provision and uptake of smoking cessation support options (including nicotine vaping products [NVPs]) could be improved. Objective 1: Review the evidence for the effectiveness of interventions (implementation strategies), which were implemented on a national or state-wide scale, aiming to increase the provision of smoking cessation treatment in primary care. Objective 2: Describe and characterise the extent to which NVP use has been recorded in primary care electronic health records in the UK. Objective 3: Examine interactions between health professionals and people who smoke with and without common mental health conditions (depression and/or anxiety), about smoking cessation and nicotine vaping products. Objective 4: Assess cessation aid utilisation by people who smoke with and without common mental health conditions (depression and/or anxiety) used in their last attempt to quit smoking.Methods:To achieve the four objectives, four studies were conducted. Study 1: Systematic review and narrative synthesis of findings. Study 2: Exploratory analysis of Clinical Practice Research Datalink (CPRD), 2006–2022: electronic primary care patient data from ~25% of the UK population. Study 3: Using 2018 cross-sectional International Tobacco Control Four Country Smoking and Vaping Survey data from Australia, Canada, England and the United States (US), weighted logistic regression models examined the association between self-reported current diagnosis/treatment for depression and/or anxiety and health professional interactions about smoking cessation and nicotine vaping (visiting a HP; receiving advice to quit smoking from a HP; discussing NVPs with a HP; receiving a positive recommendation to use NVPs). Study 4: Using the same survey data as in Study 3, weighted logistic regression models examined the association between self-reported current diagnosis/treatment for depression and/or anxiety and what cessation support option (any cessation support, nicotine replacement therapy [NRT], varenicline or bupropion, behavioural support, or NVPs) was used at last smoking quit attempt.Results:Study 1: The systematic review identified 49 studies. Implementation strategies which involved ‘changing infrastructure’, ‘training and educating stakeholders’, and ‘engaging consumers’ increased smoking status recording and cessation advice provision in primary care. Implementation strategies which involved ‘utilizing financial strategies’ increased smoking status recording and cessation advice provision, and smoking cessation. Implementation strategies which involved ‘training and educating stakeholders’ increased smoking status recording and cessation advice provision, and smoking cessation, but the evidence was low-quality. Study 2: Using UK primary care data, I identified seven medical codes indicating current or former vaping. Vaping documentation was very low: 150,144 unique patients out of the estimated ~16 million patients registered in CPRD had ever received a vaping medical code. The first incidence of vaping documentation was in October 2011; vaping code incidence increased from September 2013. The ‘e-cigarette or vaping product use-associated lung injury’ (EVALI) outbreak in the US (and peak media coverage in September 2019) was significantly associated with a reduction in new records of current vaping, manifested as a declining trend over a period of seven months (September 2019 to March 2020); additionally, there was an immediate increase in new records of former vaping, followed by a declining trend over the subsequent seven-month period. When patients received their first vaping code, mean age was 50.2 years, 52.4% were female, and 82.1% were White. When receiving the first vaping code, the majority of patients were either smoking or had quit smoking in the past, and &lt;2% were recorded as having never smoked. Of those recorded as currently vaping, 98.9% had records of their previous smoking status, and 55.0% had records of their smoking status over a period greater than 12 months. Over a year after being recorded as vaping, 34.2% of people who were smoking prior to being recorded as vaping were still smoking, 23.7% quit smoking, 1.7% received a ‘never smoked’ status, and there was no smoking status for 40.4%.Study 3: People with anxiety and/or depression who smoke were more likely to visit a HP than those without, but only those with depression were more likely to receive cessation advice. Among those who had visited their HP, less than half (47.9%) reported receiving advice to quit smoking. Those with both depression and anxiety were more likely to discuss NVPs, compared to those without depression/anxiety. The likelihood of receiving a positive recommendation to use NVPs did not differ by mental health condition. NVP discussions and receiving a positive recommendation to use them were rare overall.Study 4: A large proportion (40%) of respondents did not use any cessation aid in their last quit attempt and there was a high rate of unsuccessful quit attempts: 76%. At their last smoking quit attempt, those with anxiety, and both anxiety and depression were more likely to use any cessation support than those without these mental health conditions. Specifically, those with depression and anxiety were more likely to use NRT, and those with depression and/or anxiety were more likely to use behavioural support, compared to those without depression/anxiety. However, the use of NVPs and varenicline/bupropion to quit smoking was similar among adults with and without depression/anxiety.Conclusions:The rate at which health professionals deliver smoking cessation advice and support is suboptimal. I found evidence towards the effectiveness of utilizing financial strategies, and some (limited) evidence towards training and educating stakeholders, on increasing smoking cessation rates. I recommend that health professionals conduct continued professional development/training to ensure that they are up to date with the smoking cessation support options that are available, and the guidance regarding their use. I recommend that cessation support options be made available to people who smoke free of charge. Also, while not all the evidence is certain for all forms of provider incentivisation, I did find some evidence that they may increase cessation rates. I recommend that future implementation strategies attempt to better align with the existing technologies and the routine systems in place. In future research, researchers could explore if there are any ways to optimise Very Brief Advice (VBA) further, and I advise that studies assess the effectiveness of implementation strategies on both (practitioner-level) provider performance as well as (patient-level) smoking outcomes.I found that the documentation of vaping in UK primary care was low but increasing over time. Given that population-level electronic health records could be employed to investigate the long-term health effects and smoking cessation outcomes of vaping, I proposed recommendations to improve the completeness, accuracy and consistency of vaping status recording, by refining medical codes for vaping, and introducing a Quality and Outcomes Framework indicator for recording vaping status.I found that there are missed opportunities for health professionals to provide cessation advice and recommendations about using NVPs to quit smoking, and to offer cessation support. Given that a large proportion of respondents did not use any cessation aid in their last quit attempt and there was a high rate of unsuccessful quit attempts, I advise that health professionals should systematically offer ongoing cessation support to all patients, regardless of mental health status. However, in order to address the disparity in smoking prevalence between those with and without mental health conditions, health professionals need to increase the rate of smoking cessation support provision to those who smoke and have mental health conditions (above the rate of provision to people who smoke without mental health conditions). As NVPs are potentially the most effective smoking cessation support option currently available, it is important that healthcare professionals provide accurate information about and access to NVPs to people who smoke, especially for individuals with mental health conditions. To achieve this, people with mental health conditions could be specifically targeted as a priority population in some of the policy recommendations recently made in the Khan review and the initiatives recently announced by the UK government, such as the national ‘swap to stop’ programme, where people who smoke will be able to switch cigarettes for NVPs.</div

Factors Associated with Quit Attempts and Smoking Cessation in Brazil: Findings from the International Tobacco Control Brazil Survey

Background:In Brazil, the treatment of tobacco dependence is available at no cost. This study aimed to identify factors associated with attempting to quit and of successful smoking cessation in a population-based sample of Brazilian smokers.Methods:Data came from the first two waves of the International Tobacco Control (ITC) Brazil Survey, conducted in 2009 and 2012/2013 in three cities: Rio de Janeiro, São Paulo, and Porto Alegre. Prospective cohort data were collected from 488 adults (≥18 years) who smoked at Wave 1 who were resurveyed at Wave 2. Crude and adjusted relative risks (RR) for two outcomes (making a quit attempt between Wave 1 and Wave 2 and successfully quitting by Wave 2) were estimated. Multivariable multilevel logistic regression models were used, whereby variables were added to the models in a series of blocks.Results:Nearly two-thirds (65.6%) of smokers attempted to quit between waves, and 23.4% had quit at Wave 2. Intention to quit smoking at Wave 1 was the only variable associated with attempt to quit by Wave 2 (OR=2.85; 95%CI 1.64-4.94; p\u3c 0.001). Smokers of higher socioeconomic status (ORhigh versus low=1.80; 95%CI 1.05-3.10; p=0.03) and lower nicotine dependence (ORlow HSI versus high HSI=1.94; 95%CI 1.10-3.43; p=0.02) were more likely to successfully quit. The presence of another adult smoker at home was negatively related to successful quitting (OR=0.50; 95%CI 0.26-0.94; p= 0.03).Conclusions:These results are generally consistent with prior research and have potential to inform governmental interventions to promote tobacco cessation, particularly among disadvantaged groups

Assessing Associations Between Emergency Room Visits for Respiratory and Cardiovascular Diseases and Criteria Air Pollutants Exposure in New York State

Abstract Air pollution is a major environmental health hazard for the general population. Approximately 90% of the global population is at risk of both indoor and outdoor air pollution, and it accounts for an estimated 7 million premature deaths every year according to the World Health Organization (WHO). Multiple studies including epidemiological and molecular analyses have confirmed the negative effects of air pollutants on human health even at levels within the WHO guidelines. This study examines the health impacts of releases of criteria air pollution from point sources in New York State (NYS). There is evidence from population studies that have shown that increases in levels of the criteria air pollutants (CAPs) are associated with increases in cardiovascular and respiratory diseases. The criteria pollutants include particulates (PM10 and PM2.5), sulfur dioxide (SO2), nitrous oxides (NOx), carbon monoxide (CO), ozone (O3), and lead (Pb), as defined by the United States Environmental Protection Agency (USEPA). While emissions from point sources such as fixed industries and power plants are only one relatively minor component of total air pollution, because they are localized can allow one to examine the effects of these releases on the local population. In this ecologic study I have determined the association between emergency room (ER) visits that did not result in hospitalization for respiratory and cardiovascular diseases in NYS among individuals living in zip codes containing point sources of CAPs. Of particular interest is the examination of the release effects of particulates relative to the gaseous pollutants that have been studied less because they are more difficult to measure. The specific aims of this dissertation project are to assess the associations, if any, between ER visits for asthma, chronic obstruction pulmonary disease (COPD), ischemic heart disease (IHD) and myocardial infarction (MI) and zip code level exposure to the CAPs, NOx, SO2, CO, and particulates (PM2.5 and PM10) among patients who live in zip codes that have point source emissions of the CAPs in NYS from 2010 to 2018 after control for other sources of air pollution and rates of smoking and level of poverty, and to determine the individual contribution of each criteria pollutant. Unfortunately, the exposure source I will use does not include information on O3 and there are minimal releases of Pb, so it will not be studied. This was achieved by using publicly available data sets, the National Emissions Inventory (NEI) by the USEPA for exposure data, the United States Decennial Census (USDC) for population data, the Behavioral Risk Factor Surveillance System (BRFSS) for smoking data, the United States Census Bureau (USCB) for poverty, and the Statewide Planning and Research Cooperative System (SPARCS) for ER visits data. In the first aim, a generalized linear model with Quasi-Poisson regression is used, while the linear mixed effects regression model with a random county level effect is used in the second and third aims to analyze the rates of ER visits for all the diseases in the study and their associations with the CAPs. A p-value of The results of this dissertation show positive associations between all of the CAPs and all of the diseases in the study except MI for which most patients are recorded as hospital admissions (HAs). A major unexpected observation is that the gaseous pollutants (CO, NOx, SO2) showed much stronger associations with asthma, COPD and IHD than the particulates (PM2.5 and PM10), although this may in part be because the gaseous air pollutants are greater from point sources. In addition, for COPD there was a greater risk from PM10 than PM2.5, indicating that while larger particulates do not penetrate deep into the alveoli, they still can increase risk of respiratory disease. These results demonstrate that CAPs point source pollution results in a small but significant contribution to the risk of respiratory and cardiovascular diseases in relation to ER visits that did not result in hospitalization. There are limitations to this study as it uses an ecologic study design that has the potential for misclassification of the exposure, and has analyzed only data from ER visits, not hospitalization. There is also a potential for residual confounding. Future research using more sophisticated study designs could better assess the research questions of interest