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Ex-smokers without spirometry or CT evidence of chronic obstructive pulmonary disease (COPD) but with mildly abnormal diffusing capacity of the lungs for carbon monoxide (DL CO) are at higher risk of developing COPD. It remains difficult to make clinical management decisions for such ex-smokers without other objective assessments consistent with COPD. Hence, our objective was to develop a machine-learning and CT texture-analysis pipeline to dichotomize ex-smokers with normal and abnormal DL CO (DL CO ≥ 75% pred and DL CO <75% pred). In this retrospective study, 71 ex-smokers (50–85 yrs) without COPD underwent spirometry, plethysmography, thoracic CT, and 3He MRI to generate ventilation defect percent (VDP) and apparent diffusion coefficients (ADC). PyRadiomics was utilized to extract 496 CT texture-features; Boruta and principal component analysis were used for feature selection and various models were investigated for classification. Machine-learning classifiers were evaluated using area under the receiver operator characteristic curve (AUC), sensitivity, specificity, and F1-measure. Of 71 ex-smokers without COPD, 29 with mildly abnormal DL CO had significantly different MRI ADC (p <.001), residual-volume to total-lung-capacity ratio (p =.003), St. George's Respiratory Questionnaire (p =.029), and six-minute-walk distance (6MWD) (p <.001), but similar relative area of the lung < −950 Hounsfield-units (RA 950) (p =.9) compared to 42 ex-smokers with normal DL CO. Logistic-regression machine-learning mixed-model trained on selected texture-features achieved the best classification accuracy of 87%. All clinical and imaging measurements were outperformed by high-high-pass filter high-gray-level-run-emphasis texture-feature (AUC = 0.81), which correlated with DL CO (ρ = −0.29, p =.02), MRI ADC (ρ = 0.23, p =.048), and 6MWD (ρ = −0.25, p =.02). In ex-smokers with no CT evidence of emphysema, machine-learning models exclusively trained on CT texture-features accurately classified ex-smokers with abnormal diffusing capacity, outperforming conventional quantitative CT measurements. [ABSTRACT FROM AUTHOR]

Cigarette smoking represents the main risk factor for cancer development; however, less is known about the effects of active smoking on the outcome of cancer patients receiving systemic treatment, radiation therapy, or surgery. A systematic review and meta-analysis were conducted searching the PubMed® and Web of Science® Library databases using specific Medical Subject Headings terms. Studies reporting on the prognostic impact of the smoking status concerning survival endpoints in cancer patients treated with systemic treatment, radiation therapy, or surgery were eligible for inclusion. Of 1.380 articles reviewed, 12 reports including data from 31.785 patients with six different cancer types were considered eligible for inclusion. According to the meta-analysis of the overall effect, active smoking during cancer treatment was associated with an impaired overall survival (OS) and cancer-specific mortality (CSM) as compared to former or never smokers (OS: hazard ratio (HR) = 1.61, 95% CI: 1.19–2.17, p = 0.007; CSM: HR = 1.25, 95% CI: 1.01–1.54, p = 0.046). Moreover, smoking cessation led to a similar OS and CSM when comparing former to never smoking patients (OS: HR = 1.01, 95% CI: 0.87–1.18, p = 0.818; CSM: HR = 1.04, 95% CI: 0.91–1.20, p = 0.324). These results underline active smoking during cancer treatment as an independent adverse prognostic factor, while smoking cessation can result in similar outcomes compared to never smokers. Limitations of the study were a substantial study heterogeneity concerning different cancer entities and variations of treatment modalities. • A metanalysis investigated data from 31.785 patients with six different cancer types. • Active smoking during cancer treatment was associated with an impaired OS. • Active smokers suffered from a poorer cancer-specific mortality. • Smoking cessation led to the similar OS and CSM compared to former or never smokers. • Result considered patients receiving surgery, radiation, and systemic treatment. [ABSTRACT FROM AUTHOR]

For human papilloma virus related (HPV+ve) primary oropharyngeal squamous cell carcinoma (OPC), blood tests can quantify circulating cell free tumor tissue modified viral (TTMV)-HPV DNA at diagnosis and after treatment during follow-up. The purpose of this study is to investigate the correlation between baseline tumor volume and pre-treatment TTMV-HPV DNA titers for HPV+ve OPC. We queried our institutional database to identify non-metastatic HPV+ve OPC patients with available pre-treatment TTMV-HPV 16 DNA scores. All patients have the gross tumor volume (GTV) for the primary (GTVp), involved lymph nodes (GTVn) and total tumor volume (TTV = GTVp + GTVn) calculated in cc on the contrast enhanced radiation treatment planning CT-scan. We excluded patients with negative and intermediate TTMV-HPV 16 pre-treatment scores, those with N0 OPC and those with HPV+ve nodes with no detected primary. Spearman's rho correlation (two tailed, significance at the 0.01 level) was performed to determine correlations among all tumor volumes and the pretreatment TTMV-HPV 16 DNA scores. We identified 29 patients who met our inclusion criteria: 90% were males, 89.6% white, median age was 64 (range = 42-81) years, 24% were current smokers and 20.1% were former smokers with median pack-years of 22.5 (range = 1.8-61) and 48.3% reported a history of alcohol use. More than half of the patients had base of the tongue location (51.7%) followed by tonsil (41.4%), with T1, T2, T3 and T4 tumors detected in 27.6%, 27.6%, 27.6% and 17.2%, whereas 38% and 62% had N2 and N1 disease, respectively. Mean (standard deviation) GTVp, GTVn, and TTV were 30.2 ± 30.9, 28.3 ± 30.4, and 58.5 ± 47.2 cc, respectively and median (range) of TTMV-HPV 16 DNA score was 483 (19-126009) fragments/ml plasma. Spearman's rho showed a significant positive moderate correlation with both GTVn and TTV and TTMV-HPV 16 DNA scores (See Table 1 below). Statistically significant correlation was not observed with GTVp. Nodal tumor volume and total tumor volume showed moderate positive correlation with pretreatment TTMV-HPV-16 DNA titers for HPV+ve OPC. *. Correlation is significant at the 0.05 level (2-tailed). [ABSTRACT FROM AUTHOR]

Smoking causes cardiovascular disease. AHRR hypomethylation at the cg05575921 site is associated with active and former smoking status at baseline, and cumulative amount of tobacco smoked. We tested the hypothesis that AHRR cg05575921 hypomethylation as an epigenetic marker of smoking history predicts the risk of myocardial infarction in former smokers. We included 10,510 individuals with methylation extent measurements and information on smoking status from the Copenhagen City Heart Study (CCHS), a prospective, cohort study of the general population carried out from 1991 to 2003. The endpoint myocardial infarction was retrieved from the national Danish Patient Registry and the national Danish Causes of Death Registry. For individuals in the 1st (lowest) quartile of AHRR cg05575921 methylation (≤49% methylation extent), 99% were ever smokers at baseline (active and former smokers combined) compared to 42% in the 4th (highest) quartile (>62% methylation extent). For former smokers, the cumulative incidence of myocardial infarction was higher in the lowest methylation extent (1st-50th percentile) compared to the highest methylation extent (51st-100th percentile). Compared to never smokers, the multivariable adjusted subhazard ratio for myocardial infarction was 1.09 (95%CI:0.88–1.35) for former smokers with the highest methylation degree, 1.38 (1.06–1.80) for active smokers with the highest methylation extent, 1.39 (1.08–1.78) for former smokers with the lowest methylation extent, and 1.61 (1.35–1.92) for active smokers with the lowest methylation extent. AHRR cg05575921 hypomethylation as an epigenetic marker of smoking history predicts risk of myocardial infarction, particularly in former smokers. Further, AHRR hypomethylation, regardless of smoking status, was associated with increased risk of myocardial infarction. Image 1 • AHRR cg05575921 hypomethylation is an epigenetic marker of smoking history. • AHRR cg05575921 hypomethylation predicted risk of myocardial infarction. • AHRR hypomethylation was associated with increased risk of myocardial infarction after adjustment for smoking. [ABSTRACT FROM AUTHOR]

Purpose: Nondaily smoking is increasing in the United States and common among Hispanic/Latino smokers. We characterized factors related to longitudinal smoking transitions in Hispanic/Latino nondaily smokers.Methods: The Hispanic Community Health Study/Study of Latinos is a population-based cohort study of Hispanics/Latinos aged 18-74 years. Multinomial logistic regression assessed the baseline factors (2008-2011) associated with follow-up smoking status (2014-2017) in nondaily smokers (n = 573), accounting for complex survey design.Results: After ∼6 years, 41% of nondaily smokers became former smokers, 22% became daily smokers, and 37% remained nondaily smokers. Factors related to follow-up smoking status were number of days smoked in the previous month, household smokers, education, income, and insurance. Those smoking 16 or more of the last 30 days had increased risk of becoming a daily smoker [vs. < 4 days; relative risk ratio (RRR) = 5.65, 95% confidence interval (95% CI) = 1.96-16.33]. Greater education was inversely associated with transitioning to daily smoking [>high school vs. Conclusions: Many Hispanic/Latino nondaily smokers became daily smokers, which may increase their risk of adverse health outcomes. Addressing different smoking patterns in primary care may be useful to prevent smoking-related diseases. [ABSTRACT FROM AUTHOR]

Donor smoking histories are common in the lung donor pool, which are known to adversely affect post–lung transplant (LTx) outcomes. However, no evidence is available about smoking status (current/former), cumulative dose effect, or the combined effect of tobacco with marijuana. We retrospectively reviewed our local state-based donation organization records and subsequent LTx recipient outcomes. The primary outcome was 3-year graft survival, with cause of death as secondary outcomes. Univariate and multivariate Cox regression analyses were used to explore smoking status or cumulative dose effect. Between 2014 and 2018, 304 LTxs were performed: 133 (44%) LTxs were from never-smoker donors, 68 (22%) from former-smoker donors, and 103 (34%) from current-smoker donors. Of the current-smoker donors, 48% had a marijuana use history. There was no significant difference in early mortality, although recipients who received transplants from current-smoker donors had a lower 3-year graft survival than those who received transplants from never smokers. Multivariate modeling showed that current tobacco smoking (hazard ratio: 2.13, 95% CI: 1.13–3.99) and a more than 5-year weekly marijuana use (hazard ratio: 2.97, 95% CI: 1.29–6.87) were independent donor factors affecting graft survival. Chronic lung allograft dysfunction accounted for a higher proportion of the causes of death within 3 years after LTx where lungs from current/former smokers were utilized compared with those from never smokers (chronic lung allograft dysfunction-cause mortality: 11%, 7%, 0%, respectively). More than 50% of LTx donors had smoking histories. Current tobacco use or more than 5-year weekly marijuana smoking history adversely affected 3-year graft survival. Our findings support the importance of obtaining a detailed donor tobacco and marijuana smoking history. [ABSTRACT FROM AUTHOR]

Smoking has negative consequences on occupational health. The current meta-analysis was conducted with the aim to pool the studies about smoking and increased disability pension. Systematic review and meta-analysis. Articles were found in the scientific literature using keywords, and searching was limited to prospective cohort studies that had been published before August 2018. Based on the inclusion and exclusion criteria, 23 prospective cohort studies were selected. The analyses were carried out on the basis of the random-effects method. Subgroup analysis was also carried out. Finally, the bias of publication was examined using Begg's test, the Egger test, the trim-and-fill method, and the funnel plot. Twenty-three studies were included. The results showed a positive association between smoking and disability pension, with a risk ratio (RR) of 1.41 and 95% confidence interval (95% CI) of 1.30–1.53 (P < 0.001). In men, the RR was equal to 1.48 and 95% CI was equal to 1.30–1.68 (P < 0.001). In women, the RR was equal to 1.23 and 95% CI was equal to 1.09–1.37 (P = 0.001). In current smokers, the RR was equal to 1.41 and 95% CI was equal to 1.26–1.57 (P < 0.001). In former smokers, the RR was equal to 1.16 and 95% CI was equal to 1.05–1.29 (P = 0.003). Qualitative evaluation showed that the studies had a low level of selection bias, data collection bias, and withdrawal and dropout bias. Smoking is a risk factor for increasing disability pension, and men are at higher risk of disability pension. In addition, both current and former smokers are in high risk of disability pension. Overall, it can be concluded that smoking is a risk factor for occupational health. • A systematic review and a meta-analysis on the effects of smoking on disability pension were performed. • The status of a smoker as a 'current smoker' or a 'former smoker' was investigated in relation to disability pension. • The role of gender differences was also examined. [ABSTRACT FROM AUTHOR]

Introduction: The relationship between e-cigarette use and cigarette smoking is the subject of ongoing debate. There is limited research on e-cigarette use and changes in the frequency of cigarette smoking. This study examines whether the frequency of e-cigarette use is associated with changes in cigarette smoking behavior among U.S. adults.Methods: The study used data (n=20,558) from Waves 1 (2013-2014) and 2 (2014-2015) of the Population Assessment of Tobacco and Health, analyzed in 2019. Multivariable multinomial logistic regression assessed the association between e-cigarette use at Wave 1 and change in cigarette smoking frequency between Waves 1 and 2.Results: Every day cigarette smokers who used e-cigarettes some days (OR=1.95, 95% CI=1.27, 2.98) and every day (OR=3.37, 95% CI=1.78, 6.36) in Wave 1 had significantly higher odds of switching to some days cigarette smoking in Wave 2. Every day smokers who used e-cigarettes every day in Wave 1 had higher odds of becoming former cigarette smokers in Wave 2. Likewise, e-cigarette use at baseline among former cigarette smokers was associated with higher odds of switching to some days cigarette smoking (experimental e-cigarette use: OR=5.43, 95% CI=2.13, 10.72; some days e-cigarette use: OR=4.78, 95% CI=2.13, 10.72). In addition, experimental smokers who were also some days e-cigarettes users in Wave 1 had significantly lower odds of switching to experimental former smokers.Conclusions: Although e-cigarette use may reduce cigarette smoking frequency among continuing smokers, findings suggest that e-cigarette use may be associated with cigarette smoking relapse among former smokers. [ABSTRACT FROM AUTHOR]

• Emerging issue in lung cancer screening is nonadherence to follow-up recommendations. • Low nonadherence rate in the National Lung Screening Trial is difficult to replicate in community settings. • Current smokers, racial minorities, and younger participants are more nonadherent. • Program coordinators sending reminder calls/letters may improve adherence. • Mobile lung screening may improve adherence in rural settings and poor. populations. The low nonadherence rates reported by large low-dose computed tomography (LDCT) lung cancer screening trials were not necessarily replicated outside of trial conditions. This systematic review and meta-analysis identified predictors of participant nonadherence to returning for annual LDCT screening. The systematic review protocol was registered at PROSPERO (CRD42019118347). MEDLINE, EMBASE, CINAHL, AgeLine, grey literature sources, and reference lists of included studies were searched until March 1st, 2020. Primary research articles were eligible for inclusion if they screened current or former smokers using LDCT as their primary screening modality and reported on participant demographics or programmatic interventions that predicted nonadherence. Risk of bias assessment was performed at both study and outcome levels. The primary outcome was predictors of nonadherence. The secondary outcomes were relative risks (RR) of second round nonadherence based on identified predictors, which were calculated using random-effects meta-analyses. Across 13 included studies (total n = 15,790; range: 157–3642), the overall rate of nonadherence was 28% (95% CI: 20–37%). Studies identified greater nonadherence in participants younger than 60 or older than 74, with longer travel distances to screening centers, and having a low risk perception of lung cancer. Meta-analyses identified higher nonadherence in community-based compared to academic-based programs, but this did not reach significance (32% versus 27%; p = 0.32). Current smokers were more likely to be nonadherent compared to former smokers (RR 1.23, 95% CI: 1.09–1.40; p < 0.01) while white participants were less likely nonadherent compared to non-white participants (RR 0.69, 95% CI: 0.60–0.81; p < 0.0001). No differences existed between male and female participants (RR 0.99, 95% CI: 0.85–1.15; p = 0.85). Programmatic interventions, including dedicated program coordinators, reminder calls/letters, and mobile LDCT scanners reduced nonadherence in lung cancer screening programs. These interventions should be targeted/tailored toward the subpopulations with the highest nonadherence rates. [ABSTRACT FROM AUTHOR]

Lung cancer is the leading cause of cancer-death worldwide. The U.S. Preventative Services Task Force (USPTSF) approved screening for current or former smokers aged 55–80 based on the results of the National Lung Screening trial (NLST). Following the NLST, new evidence has emerged from clinical trials and updates to previous trials prior to the anticipated update to the USPSTF guideline. We review the new evidence on lung cancer screening with low dose computed tomography (LDCT) and the surgical implications. A review of new literature was performed pertaining to lung cancer screening since implementation of UPSTF guidelines. Articles for inclusion were identified by both authors', then search of the Pubmed and Cochrane database was performed from January 1st, 2013 through February 4th, 2020 using the MeSH search terms: "lung cancer"; "screening"; "low dose CT". The results of these studies are summarized. We identified multiple prospective randomized control trials and meta-analysis since the NLST supporting lung cancer-specific mortality with screening. We identified new nodule classification systems and the development of risk-models which may reduce false positive rates and identify high risk patients not currently eligible for screening. Finally, we discussed the surgical implications of screening. New data supports NLST findings and show ongoing benefit to LDCT for lung cancer screening. Standardized LDCT screening classification has been shown to reduce harm and lower false positive rates. Further study is needed regarding use of risk-modeling. Screening will require an increase in the thoracic workforce to accommodate the amount of surgically operable cancers. [ABSTRACT FROM AUTHOR]

Past research indicates dual users of tobacco and alcohol find it harder to quit smoking and may be more likely to relapse. This study investigated whether post-quit alcohol use predicted smoking relapse among ex-smokers, and whether this relationship varied by length of smoking abstinence. The study included 1064 ex-smokers (18+ years) from Canada (n = 340), US (n = 314), England (n = 261), and Australia (n = 149) who participated in the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping Survey, and we conducted analyses using multivariable logistic regression. We assessed alcohol consumption in 2018 using AUDIT-C and coded as never/low, moderate or heavy level and used alcohol consumption to predict smoking status in 2020. Overall 26 % and 21 % of ex-smokers consumed alcohol at a moderate and heavy level, respectively. Compared to never/low alcohol consumption, risk of smoking relapse among those who consumed alcohol at a moderate level was significantly lower within the first year of abstinence (OR = 0.34, 95 % CI = 0.14–0.81, p = 0.015) but higher thereafter (OR = 2.44, 95 % CI = 1.13–5.23, p = 0.023). The pattern of results was similar for those who consumed alcohol at a heavy level. Overall, baseline alcohol consumption of ex-smokers did not predict their smoking relapse risk. As expected, risk differed by smoking abstinence duration. However, the pattern was unexpected among the short-term quitters as the subgroup who drank moderately/heavily had lower relapse risk than their counterparts who never drink or at low level, underscoring the need to replicate this unexpected finding. • Around 1 in 4 people who have stopped smoking consume alcohol at a moderate level. • Around 1 in 5 people who have stopped smoking consume alcohol at a heavy level. • Association of alcohol use and smoking relapse risk differs by time since quit smoking. • Smokers quit ≤1 year have lower relapse risk if they drink moderately/heavily. • Smokers quit >1 year have higher relapse risk if they drink moderately/heavily. [ABSTRACT FROM AUTHOR]

Postpartum relapse to cigarette smoking is common and relapse prevention interventions have indicated limited efficacy. Abstinence motivations and self-efficacy are two factors that might fluctuate during the postpartum period and predict smoking abstinence. The present study was a secondary analysis that examined statistical trends in motivations and self-efficacy to sustain postpartum abstinence and evaluated their association with sustained abstinence from pregnancy through 52 weeks postpartum. Former smokers (N = 300) were recruited for a parent study evaluating two postpartum behavioral relapse prevention interventions. Participants completed assessments prenatally (baseline) and at 12, 24, and 52 weeks postpartum. Motivations to sustain abstinence for internal (intrinsic motivation) and external (extrinsic motivation) reasons, for the health of the baby (baby's health motivation), to maintain a healthy pregnancy (pregnancy motivation), and to avoid children becoming smokers (parenting motivation) were measured at each assessment. Confidence in maintaining abstinence, despite negative affective experiences (internal self-efficacy) and outside circumstances (external self-efficacy), was also assessed. Smoking was biochemically verified at each assessment. Linear mixed models indicated decreasing intrinsic, baby's health, and parenting motivations from baseline to 12 and 24 weeks postpartum and increasing motivations from 24 to 52 weeks postpartum (p s <.03). Higher baseline internal self-efficacy was associated with lower probability of relapse at 24 weeks postpartum (odds ratio, 0.92; 95% CI, 0.87–0.98), although this effect became nonsignificant after adjustment for multiple statistical tests. Abstinence motivations and external self-efficacy were not significantly associated with relapse (p s >.10). Levels of abstinence motivations fluctuated from pregnancy through postpartum. Future work should investigate more potent predictors of postpartum abstinence. [ABSTRACT FROM AUTHOR]

Mediation analyses were conducted to explore the contribution of lifestyle behaviours in the ethnic pattern of poor health outcomes in Leicester, England. Cross-sectional study. The study used data on 1959 participants from the Leicester Health and Well-being Survey (2015). Lifestyle behaviours were physical activity, diet, smoking and alcohol drinking. Poor health outcomes were the presence of long-term illness and poor self-reported health. Poor health outcomes were less common in Black and Minority Ethnic groups (BMEs) than Whites. Smoking was less common in BMEs than Whites. Poor health outcomes were more common in ex-smokers and current smokers than never smokers. Health outcomes were associated with smoking even after adjusting for ethnicity. The association of ethnicity and health outcomes reduced after adjusting for smoking, suggesting that the effect was mediated by smoking. In Leicester, Whites had poorer health outcomes than BMEs, which were not mediated by physical activity, diet and alcohol drinking but were mediated by smoking. • Mediation analyses were conducted using data from the Leicester Health and Well-being Survey (2015), England. • In Leicester, Whites had poorer health outcomes than Black and Minority Ethnic groups. • In Leicester, poorer health outcomes were not mediated by physical activity, diet and alcohol drinking but by smoking. [ABSTRACT FROM AUTHOR]

Abstract Introduction Durvalumab selectively blocks programmed cell death ligand-1 (PD-L1) binding to programmed cell death-1. Encouraging clinical activity and manageable safety were reported in urothelial carcinoma, non–small-cell lung cancer (NSCLC), hepatocellular carcinoma (HC) and small-cell lung cancer (SCLC) in a multicenter phase I/II study. Safety and clinical activity in recurrent/metastatic head and neck squamous cell carcinoma (HNSCC) were evaluated in the expansion phase. Methods Patients received 10 mg/kg of durvalumab intravenously every 2 weeks for 12 months or until confirmed progressive disease or unacceptable toxicity. The primary objective was safety; clinical activity was a secondary objective. Results Sixty-two patients were enrolled and evaluable (received first dose ≥24 weeks before data cutoff). Median age was 57 years; 40.3% were human papillomavirus (HPV)-positive; 32.3% had tumour cell PD-L1 expression ≥25%, and 62.9% were current/former smokers. They had a median of 2 prior systemic treatments (range, 1–13). All-causality adverse events (AEs) occurred in 98.4%; drug-related AEs occurred in 59.7% and were grade III–IV in 9.7%. There were no drug-related discontinuations or deaths. Objective response rate (blinded independent central review) was 6.5% (15.0% for PD-L1 ≥25%, 2.6% for <25%). Median time to response was 2.7 months (range, 1.2–5.5); median duration was 12.4 months (range, 3.5–20.5+). Median progression-free survival was 1.4 months; median overall survival (OS) was 8.4 months. OS rate was 62% at 6 months and 38% at 12 months (42% for PD-L1 ≥25%, 36% for <25%). Conclusions Durvalumab safety in HNSCC was manageable and consistent with other cohorts of the study. Early, durable responses in these heavily pretreated patients warrant further investigation; phase III monotherapy and combination therapy studies are ongoing. Clinical trial registry clinicaltrials.gov NCT01693562; MedImmune study 1108. Highlights • Durvalumab monotherapy was safe in previously treated recurrent/metastatic head and neck squamous cell carcinoma. • Durable antitumour responses were observed, similar to other tumour cohorts. • Objective response rate and disease control rate were greater in patients with ≥25% vs <25% tumoural PD-L1 expression. [ABSTRACT FROM AUTHOR]

Introduction: The ability to update reward and punishment contingencies is a fundamental aspect of effective decision-making, requiring the ability to successfully adapt to the changing demands of one's environment. In the case of nicotine addiction, research has predominantly focused on reward- and punishment-based learning processes among current smokers relative to non-smokers, whereas less is known about these processes in former smokers.Methods: In a total sample of 105 students, we used the Probabilistic Selection Task to examine differences in reinforcement learning among 41 current smokers, 29 ex-smokers, and 35 non-smokers. The PST was comprised of a training and test phase that allowed for the comparison of learning from positive versus negative feedback.Results: The test phase of the Probabilistic Selection Task significantly predicted smoking status. Current and non-smokers were classified with moderate accuracy, whereas ex-smokers were typically misclassified as smokers. Lower rates of learning from rewards were associated with an increased likelihood of being a smoker or an ex-smoker compared with being a non-smoker. Higher rates of learning from punishment were associated with an increased likelihood of being a smoker relative to non-smoker. However, learning from punishment did not predict ex-smoker status.Conclusions: Current smokers and ex-smokers were less likely to learn from rewards, supporting the hypothesis that deficient reward processing is a feature of chronic addiction. In addition, current smokers were more sensitive to punishment than ex-smokers, contradicting some recent findings. [ABSTRACT FROM AUTHOR]

Objective Although it has been found that identity constructs related to smoking are associated with changes in smoking behaviour, the direction of causal associations is as yet unclear. This study aims to clarify the nature and direction of these associations. Methods In this longitudinal study we examined the reciprocal relations between identity constructs (i.e., smoker self-identity, quitter self-identity and smoker group-identity), intention to quit and smoking and quitting behaviour among a sample of 1036 smokers and ex-smokers, using cross-lagged structural equation modelling. Moreover, we tested whether these relations differed by socio-economic status (SES). Results Identity and smoking behaviour were reciprocally related in that in intention to quit and smoking behaviour consistently predicted identity change, and identity predicted (changes in) intentions to quit and smoking behaviour. Behaviour appears more important for identity change than identity for behaviour change. Furthermore, quitter self-identity appears more important than smoker self- and group-identity. Relationships did not differ significantly between SES-groups. The findings were replicated using a cross-validation sample. Conclusion Results imply that changing smoking behaviour may be a vehicle to change smoking-related identity. Moreover, strengthening identification with quitting is more crucial for quit success than decreasing smoker identities. The finding that behaviour may be more important for identity than vice versa, if replicated, may call for additions to identity theories. [ABSTRACT FROM AUTHOR]

Addiction to cigarettes presents with considerable health risks and induces high costs on healthcare resources. While the majority of cigarette smokers endorse the desire to quit, only a small percentage of quit attempts lead to full abstinence. Failure to achieve abstinence may arise from maladaptive reactivity in fronto-striatal regions that track positive and negative valence outcomes, thus biasing the choice to smoke in the presence of alternative, non-drug reinforcement. Alternatively, long-term nicotine abstinence may reveal neural substrates of adaptive valence outcome processing that promote and maintain smoking cessation. The present study set out to examine the neural correlates of operant response outcomes in current smokers, ex-smokers and matched controls using a monetary incentive delay task during functional MRI. Here we report that compared to controls, both current smokers and ex-smokers showed significantly less activation change in the left amygdala during positive response outcomes, and in the anterior cingulate cortex, during both positive and negative response outcomes. Ex-smokers, however, demonstrated significantly greater activation change compared to smokers and controls in the right amygdala during negative response outcomes. Activation change in the anterior cingulate cortex and middle frontal gyrus of smokers was significantly negatively correlated with nicotine dependence and cigarette pack-years. These results suggest a pattern of shared and divergent reactivity in current smokers and ex-smokers within corticolimbic regions that track both positive and negative operant response outcomes. Exaggerated adaptive processing in ex-smokers may promote long-term smoking cessation through amplified negative valence outcome monitoring. [ABSTRACT FROM AUTHOR]

Introduction: Because of the rapidly increasing use of electronic cigarettes (e-cigarettes), this study aimed to investigate the individual characteristics and state-level prevalence of U.S. adults who have switched to e-cigarettes from traditional cigarettes.Methods: Data from the 2012-2013 and 2013-2014 National Adult Tobacco Surveys were analyzed in 2016. Relative percent change in switching was estimated, and the state-specific prevalence of adults who switched to e-cigarettes from traditional cigarettes was calculated and mapped. Multivariate logistic regression was conducted to examine how switching varied by sociodemographic subgroups and region.Results: Overall, the number of individuals who switched from traditional cigarettes to e-cigarettes increased by approximately 100% over the 1-year interval. Significant increases were found among a number of sociodemographics and regions. Multivariate logistic regression analyses showed that young adults and those living in the South and West were more likely to switch to e-cigarettes, compared to former smokers who did not switch. Compared with current dual users, those with higher education and those who were not single were more likely to switch to e-cigarettes. The state with the highest prevalence of switching was New Mexico (7.3%), whereas Connecticut had the lowest prevalence (0.8 %) among former smokers.Conclusions: There is an increase in the progression from traditional cigarette use to e-cigarette use. Further research is warranted to determine whether this change continues and facilitates cigarette smoking cessation as a possible public health benefit and opportunity to save lives rather than constitutes a potential threat to public health. [ABSTRACT FROM AUTHOR]

• Current smokers reported worse quality of life over a 24-month period. • After radical cystectomy, current smokers also reported higher pain levels. • Smokers should be counseled on the potential for worse convalescence after surgery. Radical cystectomy (RC) has the potential to impact health-related quality of life (HRQOL). Many patients who undergo RC are current or former smokers. To better inform preoperative patient counseling, we examined the association between smoking status and HRQOL after RC. A secondary analysis was performed on a prospective, longitudinal study (2008–2014) examining HRQOL in patients undergoing RC for bladder cancer. We analyzed 12 validated patient-reported outcome measures that focused on functional, symptomatic, psychosocial, and global HRQOL domains. Measures were collected pre-operatively and 3-, 6-, 12-, 18-, and 24-months postoperatively. For each HRQOL domain, we estimated the mean domain scores using a generalized estimation equation linear regression model. Each model included survey time, smoking status, and time-smoking interaction as covariates. Pairwise comparisons of current, former, and never smokers were estimated from the models. Of the 411 patients available for analysis, 29% (n = 119) never smoked, 59% (n = 244) were former smokers, and 12% (n = 48) were current smokers. Over the follow-up period, never smokers compared to current smokers had better global QOL scores (mean difference = +8.9; 95% CI 1.3–16; p = 0.023) and lower pain levels (mean difference = −10; 95% CI −19 to −0.54; p = 0.036). Compared to current smokers, former smokers had marginal improvements in global QOL (+6.9 points) and pain (−7.5 points) during the follow-up period. Current smokers reported worse HRQOL recovery in the 24-months after RC. These findings can be used to counsel patients who smoke on recovery expectations. [ABSTRACT FROM AUTHOR]

There is little research on public support for banning the sale and purchase of combustible cigarettes even though a ban is an essential step towards achieving the endgame for tobacco products. We report the first studies designed to (a) examine predictors of support for a ban (Study 1), and (b) test interventions to increase such support (Studies 2–4). In Study 1, current, former, and never smokers (N = 479) were randomized to conditions measuring their willingness to ban the sale of cigarettes vs. an unspecified product. Smokers were randomized to a persuasive communication in Study 2 and a paradoxical thinking intervention in Study 3 (N s = 300 and 302, respectively). In Study 4 (N = 336), we randomized smokers to self-persuasion and issue-framing interventions. Whereas nonsmokers were willing to ban the sale of both cigarettes and equivalent products, current and former smokers exempted cigarettes from a ban. Reactance to prohibition and perceived effectiveness predicted willingness to ban cigarette sales in all three smoking status groups (Study 1). Neither persuasive communication nor paradoxical thinking increased support for banning cigarette sales in Studies 2–3. However, self-persuasion and framing the ban as "protecting Americans from avoidable harm" both led to increased support for banning cigarette sales (Study 4). Reactance and doubt about the effectiveness of banning the sale of cigarettes are key barriers to supporting a ban. Self-persuasion and issue framing may be effective means of mobilizing policy support among smokers. The present research offers new insights relevant to promoting the "Tobacco Endgame" and helps specify directions for future research on public support for health policies. • Unlike smokers, nonsmokers would ban sales of cigarettes and other harmful products. • Beliefs about effectiveness and views of prohibition predicted willingness to ban. • Neither direct persuasion nor paradoxical thinking increased support for a ban. • A self-persuasion intervention promoted support for a ban on cigarette sales. • Framing a ban in terms of "protecting Americans from harm" led to increased support. [ABSTRACT FROM AUTHOR]

• Experiencing a cardiovascular disease-related event affects quality of life in the ageing population only for the first few years after experiencing said event. • Depression and regular moderate to vigorous physical activity plays a significant role in determining quality of life in the ageing population. • Present study was conducted over 17 years and modelled the association structure of baseline demographic characteristics, cardiovascular disease, and quality of life. The aim of this paper is to demonstrate how graphical chain models can be used to model how cardiovascular disease affected quality of life in later life over the course of 17 years of data. Waves 1-9 of the English Longitudinal Study of Ageing was used to investigate how quality of life changed over each wave using the CASP-19 questionnaire, and whether having experienced a cardiovascular event had an effect on quality of life. A total of 12,099 participants were included in the study. Participants had a mean age of 64.2 years, the majority of which were over 50 years old. Older people are more likely to have cardiac events. A one-unit rise in CES-D 8-item score was related with a 14% increased risk of CVD at Wave 1. Those with an O-level, A-level, or degree (or equivalent) had lower CVD risks than those with no education. Women had half the CVD risk of men. Living alone reduced the risk of a CVD-event by 15%. Moderate and vigorous exercise lowered cardiac event risk compared to no exercise. Current or ex-smokers have a 30% higher risk of CVD than non-smokers. Cardiovascular event was significantly associated with quality of life at waves 1 and 2 only. Events related to cardiovascular disease only affected quality of life in later life up to 4 years. Factors such as age, depression, perceived position on social ladder, and high levels of physical activity affected quality of life throughout the majority of waves. [ABSTRACT FROM AUTHOR]

Background A user-friendly method for assessing lung cancer risk may help standardize selection of current and former smokers for screening. We evaluated a simple 4-factor model, the Pittsburgh Predictor, against two well-known, but more complicated models for predicting lung cancer risk. Methods Trained against outcomes observed in the National Lung Screening Trial (NLST), the Pittsburgh Predictor used four risk factors, duration of smoking, smoking status, smoking intensity, and age, to predict 6-year lung cancer incidence. After calibrating the Bach and PLCO M2012 models to outcomes observed in the low-dose computed tomography arm of the NLST, we compared model calibration, discrimination, and clinical usefulness (net benefit) in the NLST and Pittsburgh Lung Screening Study (PLuSS) populations. Results The Pittsburgh Predictor, Bach, and PLCO M2012 represented risk equally well, except for the tendency of PLCO M2012 to overestimate risk in subjects at highest risk. Relative to the Pittsburgh Predictor, Bach and PLCO M2012 increased the area under the receiver operator characteristic curve by 0.007–0.009 and 0.012–0.021 units, respectively, depending on study population. Across a clinically relevant span of 6-year lung cancer risk thresholds (0.01–0.05), Bach and PLCO M2012 increased net benefit by less than 0.1% in NLST and 0.3% in PLuSS. Conclusion In exchange for a small reduction in prediction accuracy, a simpler lung cancer risk prediction model may facilitate standardized procedures for advising and selecting patients with respect to lung cancer screening. [ABSTRACT FROM AUTHOR]

Introduction Suboptimal decision-making is a feature in the initiation and maintenance of substance use, often manifested in choosing for short-term benefits rather than long-term gain, and the failure to display cognitive flexibility, respectively. Studies of nicotine users typically focus on characterizing those who are already addicted; less is known about decision-making in former smokers. Methods Non- ( n = 21), former daily- ( n = 23) and current daily smokers ( n = 24), completed the contingency-shifting variant Iowa Gambling Task (csIGT), in which the reward and punishment contingencies of the decks are systematically varied after 100 trials of the ‘standard’ IGT. Scores on the standard blocks of the csIGT provided an index of emotion-based decision-making, while the contingency-shifting blocks assessed flexible decision-making. Subjective ratings were also recorded at 20-trial intervals. Results Both current and former smokers showed significantly impaired performance relative to non-smokers when making decisions during the standard blocks of the csIGT. Both former and non-smokers' awareness of the reward/punishment contingencies was significantly higher than those of current smokers at the end of the standard IGT. Both former and non-smokers had significantly better performance on the contingency shifting blocks, relative to current smokers. Conclusions The findings indicate that both current and former smokers display a suboptimal pattern of decision-making than non-smokers during the standard IGT. However, with respect to the ability to change behavior following reversed contingencies, former smokers are more similar to non-smokers than to current smokers. Former smokers were also more aware of the contingencies than current smokers. [ABSTRACT FROM AUTHOR]

Introduction Smoking related stimuli are known to increase both subjective craving and heart rate in smokers; however, little is currently known about the effects of such stimuli in former smokers. Methods Subjective craving and heart rate were measured in 38 never smokers, 20 former smokers, and 30 current smokers exposed to video clips containing neutral and smoking related cues. Results Compared with neutral cues, smoking cues significantly increased both heart rate and self-reported craving in current smokers, while in former smokers smoking cues were associated with a significant decrease in heart rate as well as with a relatively diminished increase in subjective craving. Neither craving nor heart rate was impacted by the smoking cues in never smokers. Conclusions Findings suggest that while smoking related stimuli continue to elicit modest subjective cravings in former smokers, there appears to be a marked change in the typical physiological response associated with such stimuli. [ABSTRACT FROM AUTHOR]

Aims ‘Categorical self-labels’ (e.g. thinking of oneself as a smoker or non-smoker) are important aspects of identity that can have a fundamental influence on behaviour. To explore the role identity aspects relating to smoking can play in smoking cessation and relapse, this study assessed the prospective associations between taking on a non-smoker identity following quitting and long-term abstinence. Methods A representative sample of 574 ex-smokers in England who quit smoking in the past year was followed-up at three ( N = 179) and six months ( N = 163). Post-quit identity relating to smoking (‘I still think of myself as a smoker’ or ‘I think of myself as a non-smoker’), and demographic and smoking-related characteristics were assessed at baseline. Self-reported smoking abstinence was assessed at follow-ups. Results Non-smoker identity was reported by 80.3% (95%CI 76.8–83.4) of recent ex-smokers. Younger age ( p = 0.017) and longer abstinence ( p < 0.001) were independently associated with a post-quit non-smoker identity. After adjusting for covariates, non-smoker identity ( p = 0.032) and length of abstinence at baseline ( p < 0.001) were associated with continued abstinence at three month follow-up, and baseline length of abstinence ( p = 0.003) predicted continued abstinence at six months. Conclusions The majority of people who quit smoking recently consider themselves as non-smokers. Younger people and those who have been abstinent for longer are more likely to take on a non-smoker identity. Ex-smokers who make this mental transition following a quit attempt appear more likely to remain abstinent in the medium term than those who still think of themselves as smokers. [ABSTRACT FROM AUTHOR]

Background In 2012, CDC launched the first federally funded national mass media antismoking campaign. The Tips From Former Smokers (Tips) campaign resulted in a 12% relative increase in population-level quit attempts. Purpose Cost-effectiveness analysis was conducted in 2013 to evaluate Tips from a funding agency’s perspective. Methods Estimates of sustained cessations; premature deaths averted; undiscounted life years (LYs) saved; and quality-adjusted life years (QALYs) gained by Tips were estimated. Results Tips saved about 179,099 QALYs and prevented 17,109 premature deaths in the U.S. With the campaign cost of roughly $48 million, Tips spent approximately $480 per quitter, $2,819 per premature death averted, $393 per LY saved, and $268 per QALY gained. Conclusions Tips was not only successful at reducing smoking-attributable morbidity and mortality but also was a highly cost-effective mass media intervention. [ABSTRACT FROM AUTHOR]

Introduction Previous research has demonstrated that chronic cigarette smoking and major depressive disorder (MDD) are each associated with cognitive decrements. Further, these conditions co-occur commonly, though mechanisms in the comorbid condition are poorly understood. There may be distinct, additive, or overlapping factors underlying comorbid cigarette smoking and MDD. The present study investigated the impact of smoking and MDD on executive function and emotion processing. Methods Participants (N = 198) were grouped by diagnostic category (MDD and healthy controls, HC) and smoking status (ever-smokers, ES and never-smokers, NS). Participants completed the Facial Emotion Perception Test (FEPT), a measure of emotional processing, and the parametric Go/No-go task (PGNG), a measure of executive function. Results FEPT performance was analyzed using ANCOVA with accuracy and reaction time as separate dependent variables. Repeated measures MANCOVA was conducted for PGNG with performance measure and task level as dependent variables. Analyses for each task included diagnostic and smoking group as independent variables, and gender was controlled for. Results for FEPT reveal that lower overall accuracy was found for ES relative to NS, though MDD did not differ from HC. Post-hoc analyses revealed that ES were poorer at identifying happy and sad, but not fearful or angry, faces. For PGNG, poorer performance was observed in MDD relative to HC in response time to Go targets, but there were no differences for ES and NS. Interaction of diagnosis and smoking group was not observed for performance on either task. Conclusions The results of this study provide preliminary evidence for distinctive cognitive decrements in smokers and individuals with depression. [ABSTRACT FROM AUTHOR]

The elderly population, greater than 70 years old, is the fastest growing demographic in the U.S. Nearly 50% of individuals over 60 will experience lumbar spinal stenosis and 68% will develop scoliosis and adult spinal deformity (ASD). The octogenarian group, in particular, is considered at increased risk of complications following complex spine surgery. To assess the postoperative complications in order to determine the safety of MIS-ATP fusion in octogenarians. Retrospective case series. A total of 43 patients with ASD who underwent MIS-ATP fusion surgery between January 2010 and December 2020. The Charlson comorbidity index (CCI), American Society of Anesthesiologists (ASA), 30 days, one-year postoperative mortality. Demographic data included age, sex, BMI, number of fused segments, operation time, estimated blood loss, length of hospital stay, peri- and postoperative complications. A total of 43 patients with ASD who underwent surgery between January 2010 and December 2020 were retrospectively reviewed. Inclusion criteria were octogenarian adults (80-89 years old) with lumbar spinal deformity (scoliosis and/or kyphosis) treated with combined anterior (MIS-ATP) posterior (percutaneous fixation) fusion. The CCI was calculated, and outcomes measured were 30 days and one-year post-operative mortality. Demographic data included age, sex, BMI, number of fused segments, operation time, estimated blood loss, length of hospital stay, perioperative and postoperative complications. A total of 43 patients were included for analysis in this study with an average age of 82.3 years old (range: 80-88 years). Of these, 24 patients were female (55.8%) and the average BMI was 28.0. Three patients (7.0%) were active smokers, 13 (30.2%) former smokers, 27 (62.8%) never smoked, and 7 patients (16%) reported alcohol consumption. The studied operative parameters (in averages) were: levels fused (3.9), operative time (3.1 hours), operative blood loss (412 cc) and length of hospital stay (7.5 days). Overall, the average CCI and ASA score were 5 and 3 respectively. Thirteen patients (30.2%) experienced complications (hardware-related, neurological, infectious and cardiovascular) of whom 6 (14.0%) required a revision surgery. No mortalities were noted at 30 days and at 1-year after surgery. Two patients died 2-3 years after surgery, from medical reasons unrelated to the spinal surgery. This study highlights the relative safety of MIS-ATP surgery in the octogenarian population, despite the underlying medical vulnerability. Satisfactory recovery can still be achieved without major increase in operative morbidity and mortality. Posterior longitudinal rod implants (Approved for this indication), Iliac screws (Approved for this indication), pedicle screws (Approved for this indication), interbody cage fusion (Approved for this indication). [ABSTRACT FROM AUTHOR]

Many studies have validated the clinical signficance of smoking on disc degeneration and adverse outcome in spine health. A paucity of literature exists on the relationship between the biomarkers and the disc degeneration. Smoking is associated with IVDD (intervertebral disc degeneration). This study was designed to characterize metabolic responses in cervical and lumbar IVDs based on smoking status. All patients undergoing elective anterior cervical fusion, lumbar discectomy and lumbar interbody fusion in an ongoing disc biomarker study were included after the IRB approval and obtaiing informed consent. Significance between smoking status with region and Pfirrmann grade were determined using a One-Way ANOVA with Tukey post-hoc analysis with significance set at p<0.05. Smoking was recorded as nonsmoking (NS), former smoker (FS) or current smoker (CS). IVD tissues from surgery were recovered, and two explants/IVD were created. They were cultured for 3 days and tested for MMPs (1, 2, 3, 7, 8, 9, 13), TIMPs (1, 2, 3, 4), GRO-α, MCP-1, MCP-3, TNF-α, IL-1RA, IL-6, IL-8, MIP-1α, MIP-1ß, RANTES, PGE2, PDGF-AA, PDGF-AB/BB, and VEGF using Luminex assays. Lumbar IVDs from FS produced significantly lower IL-RA and MMP-13 compared to NS, and MMP-7 compared to CS. Cervical IVDs from CS produced significantly higher levels of MMP-2, MCP-1, RANTES, IL-1RA, and PDGF-ABBB, and lower levels of MCP-3, compared to NS and/or FS. FS produced significantly lower levels of MMP-8 compared to NS and CS. For NS and CS, inflammatory and degrative biomarkers increased as Pfirrmann grade increased. FS produced significantly lower levels of MMP-8 compared to NS and CS. At Pfirrmann grade 4, NS produced lower levels of TIMP-3 and TIMP-4 than FS, and FS produced lower levels of MMP-2 than CS. CS produced significantly higher levels of inflammatory and degradative biomarkers at each Pfirrmann grade. FS produced significantly lower levels of MMP-8. NS produced significantly lower levels of MMP-2 and RANTES at Pfirrmann grade 3 and MMP-7 at Pfirrmann grade 5 than CS. NS and FS produced lower levels of PDGF-AB/BB than CS. Inflammatory and degradative biomarkers increased as Pfirrmann grade increased in NS more than CS. Smoking has a greater effect on cervical IVD responses than lumbar IVD. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Purpose: Aim was to assess CT characteristics of lung nodules in never and former smokers compared to current smokers in a population-based setting.Method: We included individuals aged 45-60 years taking part in the ImaLife (Imaging in Lifelines) study, with at least one solid lung nodule (≥30 mm3) on low-dose chest CT. Qualitative (location, shape, margin, nodule type, attached structures) and quantitative (count, diameter, volume) nodule characteristics were evaluated. Based on Fleischner criteria, 'high risk' nodules were defined. To examine the association between smoking status and nodule CT characteristics of participants, multi-level multinomial logistic regression corrected for clustering of nodules within participants was performed, where all odds ratios (aORs) were adjusted for age and sex.Results: Overall, 1,639 individuals (median age: 55.0, IQR:50.5-58.5, 50.5% men) were included, with 42.1% never smokers, 35.3% former smokers and 22.6% current smokers. A total of 3,222 solid nodules were identified; 39.7% of individuals had multiple nodules. Nodule size, location, type and attachment were similar for never compared to current smokers. The odds of nodules with an irregular shape and irregular margin was lower in never smokers (aOR:0.64, 95 %CI:0.44-0.93; aOR:0.60, 95 %CI:0.41-0.88, respectively) and former smokers (aOR:0.61, 95 %CI:0.41-0.90; aOR:0.57, 95 %CI:0.38-0.85, respectively) compared to current smokers. The odds of a detected nodule being 'high risk' was similar for never versus current smokers (never smokers: aOR = 0.90; 95% CI:0.73-1.11).Conclusions: CT-based characteristics of solid lung nodules in never and former smokers differed only slightly from current smokers. Among individuals with solid nodules, 'high-risk' nodules were equally common in never smokers and current smokers. [ABSTRACT FROM AUTHOR]

With the declining sales of cigarettes, the tobacco industry has been promoting other forms of combustible and smokeless tobacco to current and former cigarette smokers. Exposure to the promotion of tobacco products has been shown to vary by income level. We combined the 2006 through 2011 National Surveys on Drug Use and Health to compare the prevalence and patterns of other tobacco use (cigar, snuff, and chewing tobacco) between current and former cigarette smokers by income level. Other tobacco use was minimal among females and among male non-smokers. Approximately a third of both current and former male cigarette smokers reported past-year other tobacco use. Overall, current smokers were more likely than former smokers to have used cigars (adjusted odds ratio (AOR) 1.69, 95% CI 1.50-1.92) or snuff (AOR 1.14, 95% CI 1.01-1.28) in the past year. The association of smoking status with other tobacco use differed by income level (interaction term p-value<0.001). Among lower income groups, current smokers were more likely to use cigars and snuff compared to former smokers. Among the highest income group, former smokers were just as likely to use smokeless tobacco as current smokers. The differing patterns of use of other tobacco between current and former smokers by income level highlight a need for studies to understand the motivations for the use of these products and their role in smoking cessation. [ABSTRACT FROM AUTHOR]

Background: E-cigarettes may be effective smoking cessation aids and their use by smokers has been growing rapidly. It is important to observe and assess natural patterns in the use of e-cigarettes whilst experimental data accumulates. This paper reports the prevalence of e-cigarette awareness, beliefs and usage, including brand choice, and characterises the socio-demographic and smoking profile associated with current use, among the general population of smokers and recent ex-smokers. Methods: Data were obtained from 3538 current and 579 recent ex-smokers in a cross-sectional online survey of a national sample of smokers in Great Britain in November and December 2012. Differences between current and recent ex-smokers in the prevalence of e-cigarette awareness, beliefs and usage were examined and the socio-demographic and smoking profile associated with current use of e-cigarettes was assessed in a series of simple and multiple logistic regressions. Results: Ninety-three percent of current and recent ex-smokers (n=3841) were aware of e-cigarettes. Approximately a fifth (n=884) were currently using e-cigarettes, whilst just over a third (n=1507) had ever used them. Sixty-seven percent of the sample (n=2758) believed e-cigarettes to be less harmful than cigarettes; however, almost a quarter (n=994) remained unsure. Among both current and recent ex-smokers, the most popular reasons for using were health, cutting down and quitting (each >80%) and 38% used the brand ‘E-lites’. Among current smokers who were aware of but had never used e-cigarettes, approximately half (n=1040) were interested in using them in the future. Among current smokers, their use was associated with higher socio-economic status (OR=1.48, 95%CI=1.25–1.75), smoking more cigarettes (OR=1.02, 95%CI=1.01–1.03) and having a past-year quit attempt (OR=2.82, 95%CI=2.38–3.34). Conclusions: There is a near universal awareness of e-cigarettes and their use appears to be common among smokers in Great Britain although a quarter of all smokers are unsure as to whether e-cigarettes are less harmful than cigarettes. E-lites – a brand that delivers a low dose of nicotine – is the most popular. E-cigarette users appear to have higher socio-economic status, to smoke more cigarettes per day and to have attempted to quit in the past year. [Copyright &y& Elsevier]

Abstract: It has been speculated that attentional bias (AB) to smoking cues is a permanent feature of addiction. The objective of the present study was to investigate if abstinence duration has an influence on AB. Performance on a visual probe task of three groups (recent, intermediate and prolonged) of ex-smokers (n =62, mean age 50±11years) with different abstinence durations was compared. Target/Control images were presented at three stimulus onset asynchronies (SOAs: 200, 500, and 2000ms) on a 17-inch monitor. Former smokers avoided target images (TIs). Mean reaction time to control images was shorter than to TIs, confirming the attentional avoidance of TIs. Attentional avoidance of TIs and the lower emotional valence of these stimuli may have been a strategy to avoid relapse. Sustained avoidance to smoking-related cues may be a predictor of long-term abstinence. Direct training of AB away from drug cues may improve the results of smoking cessation therapy. [Copyright &y& Elsevier]

Abstract: Objective: To assess behavior change over 12months in users of e-cigarettes (“vapers”). Methods: Longitudinal Internet survey, 2011 to 2013. Participants were enrolled on websites dedicated to e-cigarettes and smoking cessation. We assessed use of e-cigarettes and tobacco among the same cohort at baseline, after one month (n =477) and one year (n =367). Results: Most participants (72%) were former smokers, and 76% were using e-cigarettes daily. At baseline, current users had been using e-cigarettes for 3months, took 150 puffs/day on their e-cigarette and used refill liquids containing 16mg/ml of nicotine, on average. Almost all the daily vapers at baseline were still vaping daily after one month (98%) and one year (89%). Of those who had been vaping daily for less than one month at baseline, 93% were still vaping daily after one month, and 81% after one year. In daily vapers, the number of puffs/day on e-cigarettes remained unchanged between baseline and one year. Among former smokers who were vaping daily at baseline, 6% had relapsed to smoking after one month and also 6% after one year. Among dual users (smokers who were vaping daily at baseline), 22% had stopped smoking after one month and 46% after one year. In dual users who were still smoking at follow-up, cigarette consumption decreased by 5.3 cig/day after one month (from 11.3 to 6.0 cig./day, p =0.006), but remained unchanged between baseline and 1-year follow-up. Conclusions: E-cigarettes may contribute to relapse prevention in former smokers and smoking cessation in current smokers. [Copyright &y& Elsevier]

Background: Past research indicates that smokers with a large number of smoking friends within their social network are less interested in quitting, less likely to attempt to quit, and less likely to successfully quit. The extent to which a pro-smoking social network may increase relapse risk among ex-smokers is unclear. This study investigated among ex-smokers whether the number of close friends who smoke and changes in this number influence relapse risk.Methods: The study was a prospective cohort study of 551 adults who participated in the Australian and UK arms of the International Tobacco Control (ITC) project and were ex-smokers at wave 9 (2013) and followed up to wave 10 (2014). Logistic models regressed smoking relapse at follow-up on the baseline number of their five closest friends who smoked and changes in this number over time.Results: Ex-smokers who reported having 4 or 5 smokers among their five closest friends were more likely to relapse than those who had no smokers among their five closest friends (adjusted odds ratio [AOR] = 4.86, 95% confidence interval [CI] = 1.48-15.99, p = .009). Ex-smokers who gained smoking friends over time, but not those who lost smoking friends, were also more likely to relapse compared to those with the same number of smoking friends over time (AOR = 4.52, 95% CI = 2.15-9.52, p < .001; AOR = 1.08, 95% CI = 0.49-2.36, p = .848, respectively).Conclusions: This study demonstrated that relapse risk was elevated among ex-smokers who had more smokers among their close friends and also among those where the number of smokers in their social network increased over time. [ABSTRACT FROM AUTHOR]

Abstract: Background: Most smokers who quit smoking gain weight. There are some interventions designed to limit weight gain following smoking cessation. Objective: To conduct a systematic review to evaluate if combination pharmacological therapy interventions for smoking cessation are effective in reducing post-cessation weight gain. Methods: The following databases were researched: Medline, PubMed, PsycINFO, CENTRAL and EMBASE. Detailed inclusion and exclusion criteria were specified a priori before conducting abstract and full text screening. Included studies were required to: (1) report data on combination pharmacotherapy including at least one FDA-approved smoking cessation medication; (2) report outcome measure of weight change from baseline to the end of follow up; (3) incorporate a minimum of 2-week follow-up; (4) recruit adult smokers. Studies were excluded if they had (1) behavioral interventions; (2) sample size of <30; (3) switching medications; or (4) they were not written in English. Abstracts and the full texts were reviewed independently by two investigators. Inclusion of studies was decided by a third independent investigator in case of disagreement between the two primary investigators. Results: Out of 1873 studies identified, 1083 studies were included for abstract screening. Finally, 12 studies met the eligibility criteria after full text screening of 242 studies. Seven studies showed that participants in the combined therapy group had less post-cessation weight gain than those in the group of individual drugs or placebo. Four studies did not report differential weight gain measures by treatment groups. Only one study showed that post-treatment weight gain in the combined therapy group was more than the monotherapy group, although the result was not statistically significant. Conclusions: Seven out of twelve studies indicated that combination smoking cessation medications had less post-cessation weight gain than monotherapy or placebo in short term. Long term weight gain was not well documented by most of the studies and future research is warranted. [Copyright &y& Elsevier]

Abstract: T cells are accumulated in the lungs of chronic obstructive pulmonary disease (COPD) patients. Intraepithelial T cells, expressing the integrin αE (CD103) β7, and regulatory T cells have been implicated in pathogenesis of the disease. We asked whether COPD patients and smokers have altered frequencies of these T cells and if their phenotypes differ. A total of 40 never-smokers, 40 smokers with normal lung function and 38 COPD patients (GOLD I and II), of which 11 were ex-smokers, were included. T cells in bronchoalveolar lavage (BAL) fluid and peripheral blood were analysed for the expression of CD103, FOXP3 and markers of activation and differentiation using multi-colour flow cytometry. Smokers, regardless of airway obstruction, had significantly more CD8+CD103+ cells in their BAL fluid compared to never-smokers but less of those cells were CD27+CD69−. Smokers, in particular those with chronic bronchitis, had a higher percentage of CD4+FOXP3+ T-regulatory BAL cells compared to never-smokers and COPD ex-smokers. Chronic cigarette smoking leads to an accumulation of CD8+ T cells with an altered phenotype in the airway epithelium. The increased frequency of regulatory T cells may influence the ability to regulate smoke-induced inflammation which could be decisive for disease development. Our results further indicate a reversibility of smoke-induced changes. [Copyright &y& Elsevier]

Abstract: Background: Although data clearly link major depression and smoking, little is known about the association between dysthymia and minor depression and smoking behavior. The current study examined changes in smoking over 3years for current and former smokers with and without dysthymia and minor depression. Methods: Participants who were current or former daily cigarette smokers at Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions and completed the Wave 2 assessment were included in these analyses (n =11,973; 46% female). Analyses examined the main and gender-specific effects of current dysthymia, lifetime dysthymia, and minor depression (a single diagnostic category that denoted current and/or lifetime prevalence) on continued smoking for Wave 1 current daily smokers and continued abstinence for Wave 1 former daily smokers. Results: Wave 1 current daily smokers with current dysthymia (OR=2.13, 95% CI=1.23, 3.70) or minor depression (OR=1.53, 95% CI=1.07, 2.18) were more likely than smokers without the respective diagnosis to report continued smoking at Wave 2. Wave 1 former daily smokers with current dysthymia (OR=0.44, 95% CI=0.20, 0.96) and lifetime dysthymia (OR=0.37, 95% CI=0.15, 0.91) were less likely than those without the diagnosis to remain abstinent from smoking at Wave 2. The gender-by-diagnosis interactions were not significant, suggesting that the impact of dysthymia and minor depression on smoking behavior is similar among men and women. Conclusions: Current dysthymia and minor depression are associated with a greater likelihood of continued smoking; current and lifetime dysthymia are associated with a decreased likelihood of continued smoking abstinence. [Copyright &y& Elsevier]

Objective: While the majority of women quit smoking either before or during pregnancy, 60 to 80% relapse in the postpartum period. The objective of this research was to examine postpartum women who quit smoking during their pregnancies and to determine the predictive factors for relapse in the postpartum period by identifying different subgroups that predict risk of relapse. Method: One hundred forty four postpartum women who were abstinent at the time of delivery were recruited. Data regarding the Acquisition Stage of Change, Decisional Balance and Situational Temptations to Smoke were assessed in the immediate postpartum period. Based on their intention to remain abstinent, 121 women identified in the acquisition-Precontemplation (aPC) group comprised the study sample. Smoking status was assessed again at 2months postpartum. Results: A cluster analysis was performed to idenitfy subgroups of the acquisition-Precontemplation (aPC) group. Four subgroups were identified and were labeled Most Protected, Ambivalent, Risk Denial, and High Risk. Logistic regression was performed to establish external validity of the clusters. The clusters and exclusive breastfeeding were the only statistically significant variables associated with relapse at 2months postpartum. Conclusions: The results confirmed the clusters identified in previous prevention research with both adolescents and postpartum women, The cluster profiles can serve to guide the development of a tailored intervention program. [Copyright &y& Elsevier]

Abstract: Background: Happiness has become established as an important psychological dimension and not merely the obverse of depression and anxiety. Ex-smokers report that they are happier than when they were smoking but this could reflect biased recall. To date, no studies have examined happiness as a function of smoking status in ex-smokers of varying length of abstinence compared with current and never smokers. Methods: A cross-sectional household study of a nationally representative sample of adults examined the association between smoking status (never smoker, smoker, ex-smoker<1 year, ex-smoker≥1 year) and two standard measures of happiness adjusting for sociodemographic characteristics (N =6923). Results: After adjusting for age, gender and social grade, ex-smokers of ≥1 year reported higher levels of happiness than smokers (p <0.001) and similar levels to never smokers. Ex-smokers of <1 year had similar levels to smokers. Smoking to feel less depressed (p <0.001) or anxious (p <0.044) were the only smoking characteristics associated with lower happiness among current smokers. Conclusions: Ex-smokers who have stopped for a year or more are happier than current smokers and similar to never smokers. Whilst these results are cross-sectional and have to be interpreted with caution, this adds to the evidence that smoking may decrease happiness and stopping may increase it. [Copyright &y& Elsevier]

Abstract: Background: Elevated resting heart rate is associated with mortality in general populations. Smokers may be at particular risk. The association between resting heart rate (RHR), smoking status and cardiovascular and total mortality was investigated in a general population. Methods: Prospective study of 16,516 healthy subjects from the Copenhagen City Heart Study. 8709 deaths, hereof 3821 cardiovascular deaths, occurred during 33years of follow-up. Results: In multivariate Cox models with time-dependent covariates RHR was significantly associated with both cardiovascular and total mortality. Current and former smokers had, irrespective of tobacco consumption, greater relative risk of elevated RHR compared to never smokers. The relative risk of all-cause mortality per 10bpm increase in RHR was (95% CI): 1.06 (1.01–1.10) in never smokers, 1.11 (1.07–1.15) in former smokers, 1.13 (1.09–1.16) in moderate smokers, and 1.13 (1.10–1.16) in heavy smokers. There was no gender difference. The risk estimates for cardiovascular and all-cause mortality were essentially similar. In univariate analyses, the difference in survival between a RHR in the highest (>80bpm) vs lowest quartile (<65bpm) was 4.7years in men and 3.6years in women. In multivariate analyses, the difference was about one year in never smokers and about two years in current and former smokers. Conclusions: In a healthy population resting heart rate is associated with total and cardiovascular mortality. Elevated resting heart rate is associated with greater risk in subjects with a history of smoking than in never smokers. [Copyright &y& Elsevier]

Abstract: Introduction: Accurately assessing quit attempt history is important to develop population estimates of cessation and to increase our understanding of smoking trajectories. Thus, the current study investigated failure to report quit attempts as a function of length of quit attempt by time since quit attempt over the past year. Methods: The present study used data from the Smoking Toolkit Study, a series of population-based surveys of smokers and recent ex-smokers in England aged 16years and older. Among the 11,772 smokers identified at baseline (24.4% of the total sample), this study focused on the 4234 participants (36.0% of current smokers) who reported between one and three quit attempts in the past year. Results: There was a strong trend for quit attempts that lasted for shorter periods of time to fail to be reported. After three months, 90.1% of those lasting less than one day, 63.7% of those lasting between a day a one week, and 38.9% of those lasting between one week and one month failed to be reported. Conclusion: A large proportion of unsuccessful quit attempts fail to be reported, particularly if they only last a short time or occurred longer ago. Therefore, population estimates of quit attempts based on retrospective data may be considerable underestimates and estimates of the success of quit attempts may be overestimates. Future research is needed to establish whether there is differential reporting of quit attempts as a function of features of attempts such as use of cessation aids. [Copyright &y& Elsevier]

Abstract: Helping smokers quit is important as smoking is the number one preventable cause of death in the U.S. Smoking activates the mesolimbic dopamine reward system which is also responsible for pleasure associated with other behaviors, including engaging in novel, exciting and/or challenging (i.e., self-expanding) events. We hypothesized that the reward activation achieved by experiencing self-expanding events can supplant the reinforcement normally provided by smoking and can thus facilitate quitting. We investigated this hypothesis among 74 current and 66 former smokers who reported the self-expanding events they experienced for the 2months prior to their most successful or final, quit attempt, respectively. Former smokers, compared to current smokers, reported significantly more self-expanding events and that the events were more helpful to their quitting. For current smokers, there was a significant moderate-to-large positive correlation between number of self-expanding events and number of days subsequently abstained from smoking. The results support the proposition that experiencing self-expanding activities or events can be beneficial for smoking abstinence. [Copyright &y& Elsevier]

Background: Epidemiological studies have consistently reported that active cigarette smoking is inversely associated with endometrial cancer risk. However, dose-response relationships with quantitative measures of active smoking or passive smoking remain less clear. Methods: Data on lifetime active and passive smoking were collected for 551 endometrial cancer cases and 1925 controls in a population-based case-control study conducted during 2001–2003 in Poland (Warsaw and Łódz). Results: Compared with never active smokers, active current (Odds Ratio (OR)=0.51, 95% Confidence Interval (CI): 0.39, 0.68) and former smokers (OR=0.60, 95% CI: 0.45, 0.80) were at a statistically significantly decreased risk. We did not observe statistically significant inverse dose-response relationships with increasing exposure with duration and cumulative measures. However, there was some indication that the highest category of number of years (OR=0.35, 95% CI: 0.23–0.55), intensity (OR=0.41, 95% CI: 0.24–0.69), and dose (OR=0.38, 95% CI: 0.24–0.60) of smoking among current smokers had the greatest inverse association compared to never smokers. Our data did not support the presence of an inverse association with passive smoking among never active smokers (OR=0.92; 95% CI: 0.65, 1.29). Conclusion: Our results support that long-term and heavy smoking among current smokers strongly influence endometrial cancer risk. [Copyright &y& Elsevier]

Abstract: Objectives: There is a need to better understand the prevalence of use of pharmaceutical aids among former smokers, and explore concerns that those former smokers may have had about using such products. This paper examines the use of various cessation aids and strategies as well as reasons for not using cessation aids among a nationally representative sample of former smokers from Canada. Methods: Using data from the 2006 Canadian Tobacco Use Monitoring Survey (CTUMS), univariate analyses were performed to examine the use of different cessation aids, strategies to quit smoking, and reasons for not using cessation aids among former smokers who had quit in the previous two years. Results: In 2006, over one in four Canadians (27.1% or about 7.2million persons) aged 15 and older was a former smoker. Overall, female former smokers were more likely to report that they reduced their consumption of cigarettes as a quitting strategy, whereas male former smokers were more likely to report using a pharmacological aids when quitting. Among reasons given for not using cessation aids, lack of trust that these products would work was the most common (15.4%), following by issue of cost (8.5%), concern about possible side effects (5.8%) and lack of information about products (1.8%). Conclusion: These results suggest that men and women use different approaches to quit smoking. Our findings provide new insight which could be used to target cessation programs to the individuals where they are most likely to be effective. [Copyright &y& Elsevier]

Abstract: The ability to recruit qualified subjects who are willing to adhere to the study protocol in clinical trials is an essential component of translational research. Such tasks can be particularly challenging for chemoprevention studies when the targeted study population is healthy, at risk individuals who do not have signs or symptoms of the disease, and the study participation involves complex scheduling and invasive procedures such as bronchoscopy. In this report, we describe the recruitment process and evaluated the effectiveness of various recruitment strategies utilized in our National Cancer Institute sponsored lung cancer chemoprevention study with celecoxib. Heavy ex-smokers were recruited into the study through various methods such as radio advertisements, print media, mass mailings, flyers, internet postings and others. The number of inquiries, on-site screenees and randomization generated by each method determined the efficacy of that recruitment strategy. We prescreened 4470 individuals, invited 323 people for on-site screening and randomized 137 subjects. Radio advertisements (ads) generated the most inquiries (71.1%), followed by internet posting (11.8%), print media (6.0%), posted and racked flyers (4.4%), mass mailings (2.7%) and other strategies such as referrals from friends or family members or health care providers (2.3%). Radio ads, although costly, yielded the most subjects for on-site screening and randomization. Moreover, among the various types of radio stations, news radio stations were by far the most successful. Our results suggest that advertising on news radio is a highly effective recruitment method for successful accrual of ex-smokers into lung cancer chemoprevention trials. [Copyright &y& Elsevier]

Abstract: Very little is known about the association between cigarette use and perceived level of meaning in life, although the connection of other addictive behaviors with the feeling of meaninglessness has been widely investigated. The aim of the present study was to examine the relationship between life meaning and smoking status in a large national representative sample. A total of 12,643 people were interviewed in the Hungarostudy 2002 survey, representing the Hungarian population according to gender, age, and sub-regions of the country. Multinomial logistic regression analysis showed that meaning in life scores significantly differentiated between current and never smokers, as well as between current and former smokers. In addition, the difference in life meaning scores between never and ex-smokers was insignificant, and gender did not interact with life meaning in relation to smoking status. Further research is needed to clarify the nature and mediators of the observed relationship between life meaning and smoking in order to better understand the role of existential concerns in cigarette use. [Copyright &y& Elsevier]

Background: Evidence suggests that the transition from experimental to regular smoking is facilitated by the influence of tobacco on affective and attentional mechanisms. The objective of this study was to examine affective and attentional responses in young adult smokers using fear-potentiated startle and prepulse inhibition. Methods: Participants were 56 college nonsmokers, nonabstinent smokers, and overnight-abstinent smokers. The fear-potentiated startle test examined phasic responses to imminent threat cues and more sustained responses to unpredictable aversive events. Prepulse inhibition investigated responses to attended and ignored prepulse stimuli. Results: Abstinent and nonabstinent smokers showed increased sustained potentiation of startle to contextual cues, compared to controls. Abstinent smokers showed increased fear-potentiated startle to threat cues, compared to nonsmokers. PPI did not discriminate between abstinent or nonabstinent smokers and controls. Conclusions: These findings suggest that negative affectivity or anxiety is associated with smoking, particularly during short withdrawal. Potentiated startle may provide a valuable tool in understanding the biologic mechanisms underlying nicotine withdrawal and inform cessation and prevention efforts. [Copyright &y& Elsevier]

Abstract: Background: Current and former smokers are at increased risk to develop oral cancer. This analysis was performed to determine whether current and former smokers are more likely to undergo an exam for oral cancer than non-smokers. Methods: The Maryland Cancer Survey performed in 2002 was a population-based random digit dial, statewide survey on cancer screening and risk behaviors, targeting adults aged 40 years and older. The dataset contains self-reported information on oral cancer examinations, current smoking status, and health care access information for 4840 Maryland residents. Results: 2062 (42.6%) of Marylanders aged 40 years and older reported ever having had an oral cancer examination. Dentists and dental hygienists performed 90.9% of the exams. Current and former smokers were no more likely than those who have never smoked to have ever had the examination (adjusted OR=1.02, 95% CI=0.85–1.23 and OR=1.09, 95% CI=0.94–1.25, respectively). Other predictors associated with having an oral cancer exam included having more than a high school of education, being female, non-black, being in good to excellent health, and having a recent physical exam. Having visited the dentist in the last year had the highest odds of having ever had an oral cancer exam. Conclusions: Current and former smokers are a high-risk group who need to be targeted for oral cancer exams by dental professionals and primary care physicians. [Copyright &y& Elsevier]