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IntroductionA major site of secondhand smoke exposure for children and adults is the home. Few studies have evaluated the impact of e-cigarette or hookah use on home air quality, despite evidence finding toxic chemicals in secondhand e-cigarette aerosols and hookah smoke. We assessed the effect of e-cigarette and hookah use on home air quality and compared it with air quality in homes where cigarettes were smoked and where no smoking or e-cigarette use occurred.MethodsNon-smoking homes and homes where e-cigarettes, hookah or cigarettes were used were recruited in the New York City area (n=57) from 2015 to 2019. Particulate matter with diameter less than 2.5 µm (PM2.5), black carbon and carbon monoxide (CO) were measured during a smoking or vaping session, both in a ‘primary’ smoking room and in an adjacent ‘secondary’ room where no smoking or vaping occurred. Log transformed data were compared with postanalysis of variance Tukey simultaneous tests.ResultsUse of hookah significantly increased PM2.5levels compared with non-smoking homes, in both the primary and secondary rooms, while use of e-cigarettes increased PM2.5levels only in primary rooms. Additionally, in-home use of hookah resulted in greater CO concentrations than the use of cigarettes in primary rooms.ConclusionsUse of e-cigarettes or hookah increases air pollution in homes. For hookah, increases in PM2.5penetrated even into rooms adjacent to where smoking occurs. Extending smoke-free rules inside homes to include e-cigarette and hookah products is needed to protect household members and visitors from passive exposure to harmful aerosols and gases.

Limited studies have focused on maternal early-life risk factors and the later development of gestational diabetes mellitus (GDM). We aimed to estimate the GDM prevalence and examine the associations of maternal early-life risk factors, namely: maternal birthweight, parental smoking at birth, childhood urbanicity, ever-breastfed, parental education attainment, parental history of diabetes, childhood overall health, childhood body size, and childhood height, with later GDM. This was a retrospective cross-sectional study using the UAE Healthy Future Study (UAEHFS) baseline data (February 2016 to April 2022) on 702 ever-married women aged 18 to 67 years. We fitted a Poisson regression to estimate the risk ratio (RR) for later GDM and its 95% confidence interval (CI). The GDM prevalence was 5.1%. In the fully adjusted model, females with low birthweight were four times more likely (RR 4.04, 95% CI 1.36–12.0) and females with a parental history of diabetes were nearly three times more likely (RR 2.86, 95% CI 1.10–7.43) to report later GDM. In conclusion, maternal birthweight and parental history of diabetes were significantly associated with later GDM. Close glucose monitoring during pregnancy among females with either a low birth weight and/or parental history of diabetes might help to prevent GDM among this high-risk group.

1. Michael Weitzman, MD* 1. *Department of Pediatrics and Environmental Medicine, New York University Grossman School of Medicine, and Department of Global Public Health, New York University College of Global Public Health, New York, NY Social issues are among the most common and important influences on children’s physical and mental health, on how they develop and function, with consequences both during childhood and across the entire life span. In a widening spiral, children’s health problems in their turn may themselves result in social consequences that have further health-related effects. Pediatricians, other child health professionals, teachers and psychologists, and especially parents and other family members regularly encounter numerous social forces that affect a child’s health. For any particular child, some are noticed and others go unrecognized; some are acted on, others are not. Many, such as family and poverty, have been known about for some time. Others, such as racism, have only recently been widely recognized or fully acknowledged. Still others, such as relatively new digital technologies (eg, computers, tablets, and smartphones), as well as social media, exert strong influences on child attitudes and behavior; although many of their effects are recognized, others are still poorly understood. Still newer ones, particularly the social isolation, homeschooling, and increased screen time resulting from the coronavirus disease 2019 (COVID-19) pandemic, are only now emerging. The concept of adverse childhood experiences and the development of a scale to measure some such experiences are more than 20 years old. The scale consists of 10 items, most relating to early experiences in the child’s family: physical, sexual, or emotional abuse; neglect; and exposure to mental illness, substance abuse, incarceration, discord, or divorce. Research clearly demonstrates how frequently children encounter such experiences and the wide array of adverse health consequences associated with them, many the result of biologic changes involving inflammatory and neuro-endocrine responses. Sixty percent of all children in the …

Background Cigarette smoking, secondhand cigarette smoke (SHS) exposure, and e-cigarette use (“vaping”) are each associated with increased rates of depressive symptoms and other internalizing mental health disorders. The prevalence of vaping has increased greatly, yet the mental health correlates of secondhand exposure to e-cigarette emissions are as yet to be investigated. This study examined the potential adverse mental health outcomes associated with different tobacco exposures (direct and passive), with a particular focus on the mental health correlates of secondhand exposure to e-cigarette emissions. Methods The Population Assessment of Tobacco and Health Study data collected from a sample of 16,173 Wave 4 adults were used to test the hypothesis that secondhand e-cigarette emissions exposure is associated with increased odds of internalizing mental health disorders. Individuals were categorized as exclusive cigarette smokers, exclusive e-cigarette users, cigarette and e-cigarette dual users, exclusive noncombustible tobacco users, secondhand smoke exposed non-users, secondhand e-cigarette emissions exposed non-users, and non-users with no current SHS/secondhand e-cigarette aerosol exposure. Adjusted weighted logistic regression analysis was used to investigate the association between exposure type and internalizing problems as assessed by scores on the Global Appraisal of Individual Needs-Short Screener (GAIN-SS), a widely used instrument for assessing mental health problems. Results Cigarette smokers (AOR = 2.53, 95% CI: 2.19–2.92), e-cigarette users (AOR = 3.14, 2.41–4.09), dual users (AOR = 3.37, 2.85–4.00), noncombustible tobacco users (AOR = 1.48, 1.01–2.17), SHS exposed non-users (AOR = 1.63, 1.37–1.94), and secondhand e-cigarette emissions exposed non-users (AOR = 1.43, 1.03–1.99) were each associated with increased odds of moderate to severe internalizing mental health problems as compared to unexposed non-users. Odds of internalizing problems among SHS and secondhand e-cigarette emissions exposed non-users did not differ (p = 0.46). Conclusions This is the first study, to our knowledge, to identify an association between recent secondhand exposure to e-cigarette emissions and mental health problems, and the risk is comparable to that of SHS. Corroboration of this relationship needs further research to explicate directionality and mechanisms underlying this association.

Smoking is a risk factor for periodontal disease, and a cause of oral microbiome dysbiosis. While this has been evaluated for traditional cigarette smoking, there is limited research on the effect of other tobacco types on the oral microbiome. This study investigates subgingival microbiome composition in smokers of different tobacco types and their effect on periodontal health. Subgingival plaques were collected from 40 individuals, including smokers of either cigarettes, medwakh, or shisha, and non-smokers seeking dental treatment at the University Dental Hospital in Sharjah, United Arab Emirates. The entire (~ 1500 bp) 16S rRNA bacterial gene was fully amplified and sequenced using Oxford Nanopore technology. Subjects were compared for the relative abundance and diversity of subgingival microbiota, considering smoking and periodontal condition. The relative abundances of several pathogens were significantly higher among smokers, such as Prevotella denticola and Treponema sp. OMZ 838 in medwakh smokers, Streptococcus mutans and Veillonella dispar in cigarette smokers, Streptococcus sanguinis and Tannerella forsythia in shisha smokers. Subgingival microbiome of smokers was altered even in subjects with no or mild periodontitis, probably making them more prone to severe periodontal diseases. Microbiome profiling can be a useful tool for periodontal risk assessment. Further studies are recommended to investigate the impact of tobacco cessation on periodontal disease progression and oral microbiome.

Objectives Second-hand smoke (SHS) exposure has been identified as a risk factor for several childhood health problems including dental caries. The purpose of this study was to examine the association of postbirth SHS exposure and dental caries and to determine whether the association is independent of prenatal tobacco exposure, sugar consumption and dental utilization. Methods NHANES 2013-2014 and 2015-2016 were used to examine the research question in 1733 children, 4-11 years old with full primary or mixed dentition and serum cotinine levels below 10 ng/mL. Weighted multivariable logistic regression models were developed to examine the independent association between SHS exposure and the prevalence of (i) any dental caries experience and (ii) any decayed teeth. Results Children exposed to postbirth SHS differed from children not exposed regarding decayed teeth prevalence in the total sample (OR = 1.80, 95% CI: 1.20, 2.71) and mixed dentition (OR = 1.86, 95% CI: 1.20, 2.90) after confounder adjustment. However, no association was found in the primary dentition or between SHS exposure and total caries experience. Conclusions The findings partially show that postbirth SHS is associated with dental caries in children. However, the inconsistencies in findings across the three samples and between the two outcome measures, dental caries experience and decayed teeth prevalence raise questions regarding the validity of the hypothesis. Further, the findings suggest that postbirth SHS is likely a marker for true causes of dental caries and the association is likely confounded with other factors associated with dental caries.

Objective The study was aimed to assess risky behavioral factors in the sample of Slovak adolescents. Background Health-risk behavior contributes to the leading causes of morbidity and mortality among youth and adults. Materials and methods The Youth and Parents Risk Factor Behavior Survey (YABS), based on bilateral US-Slovak project, is an ongoing cross-sectional school-based survey initiated in Bratislava as a model region. There were 798 questionnaires for students distributed; the response rate was 64 %. The sample involved 525 adolescents aged 15‒19 years from eight selected secondary schools in Bratislava, 38 % boys and 62 % girls. More than 90 % of fathers and mothers were employed, but some families nevertheless experienced a lack of finances (48.1 %), almost 70 % of students were from complete families. Results The study revealed a very high prevalence of risky behavioral characteristics in this pilot sample of adolescents significantly related to age, gender, type of school, completeness of the family and lower parental education. CONCLUSION: The most important health risk behaviors were identified (tobacco, alcohol, drug consumption, violence, risky sexual behavior, inadequate sleep, physical inactivity, and excessive IT devices use). Targeted intervention proposals will be suggested in future (Tab. 5, Ref. 42).

ObjectivesTo estimate and compare the salivary cotinine levels using a semiquantitative method, called NicAlert, between three groups: non-smokers, daily smokers of cigarettes and daily smokers of midwakh, and to compare the carbon monoxide (CO) levels among these groups.Materials and methodsA total of 159 adult male volunteers aged 20 and above were included, with 54 current cigarette smokers, 52 current midwakh smokers and 53 non-smokers. Estimate of breath carbon monoxide and salivary cotinine were collected, as well as sociodemographic characteristics and details of smoking habits and second-hand smoke exposure among participants. Institutional review board approval was obtained and data were analysed using SPSS V.21 with the Kruskal-Wallis test used to obtain differences in the distribution.ResultsThere was no significant difference in the median breath CO and salivary cotinine levels between cigarette and midwakh smokers. Levels of breath CO were significantly higher in cigarette and midwakh smokers as compared with non-smokers (19.5, 17.5 and 6.0, respectively, pConclusionThese are the first data that we are aware of that demonstrate that in terms of at least two key biomarkers of tobacco use, there are comparable levels of exposure between cigarettes and midwakh users, demonstrating a need for intensified attention to the use of midwakh.

Cigarette smoking alters the oral microbiome; however, the effect of alternative tobacco products remains unclear. Middle Eastern tobacco products like dokha and shisha, are becoming globally widespread. We tested for the first time in a Middle Eastern population the hypothesis that different tobacco products impact the oral microbiome. The oral microbiome of 330 subjects from the United Arab Emirates Healthy Future Study was assessed by amplifying the bacterial 16S rRNA gene from mouthwash samples. Tobacco consumption was assessed using a structured questionnaire and further validated by urine cotinine levels. Oral microbiome overall structure and specific taxon abundances were compared, using PERMANOVA and DESeq analyses respectively. Our results show that overall microbial composition differs between smokers and nonsmokers (p = 0.0001). Use of cigarettes (p = 0.001) and dokha (p = 0.042) were associated with overall microbiome structure, while shisha use was not (p = 0.62). The abundance of multiple genera were significantly altered (enriched/depleted) in cigarette smokers; however, only Actinobacillus, Porphyromonas, Lautropia and Bifidobacterium abundances were significantly changed in dokha users whereas no genera were significantly altered in shisha smokers. For the first time, we show that smoking dokha is associated to oral microbiome dysbiosis, suggesting that it could have similar effects as smoking cigarettes on oral health.

Background: E-cigarette use (vaping) is an emerging public health problem. Depression has been found to be associated with e-cigarette use, and vaping and depression are each associated with elevated systemic inflammation. To date, the role of inflammation in the relationship between vaping and depression has not been explored. Objective: To assess the independent associations between e-cigarette use, depression, and inflammation, and to investigate whether the likelihood of depression among current e-cigarette users is associated with systemic inflammation. Methods: Nationally representative NHANES data from 2015–2018 were used (n = 4961). Systemic inflammation was defined as serum C-reactive protein (CRP) ≥ 8.0 mg/L. Depressed individuals were characterized by a score ≥ 10 on the Patient Health Questionnaire-9 (PHQ-9). Current e-cigarette users were defined as individuals who vaped at least once in the past 30 days and these individuals were stratified by use: exclusive users (reported smoking less than 100 combustible cigarettes in their lifetime), dual users (reported current use of electronic and combustible cigarettes), and e-cigarette users who were previous smokers. Bivariate analyses were used to assess independent associations between vaping, depression, and inflammation, and weighted logistic regression analyses adjusting for BMI, sex, and economic status were used to determine the odds ratios (ORs) for depression by e-cigarette category stratified by differential CRP levels. Results: Depression occurred in 16.7% of all e-cigarette users vs. 5.0% of those who never used e-cigarettes (p &lt, 0.001). In adjusted analyses, the following elevated ORs were found: all current e-cigarette users with CRP &lt, 8 = 3.37 (95% CI: 2.06, 5.51) vs. CRP ≥8 = 6.70 (2.48, 18.11), exclusive e-cigarette users with CRP &lt, 8 = 1.91 (0.78, 4.69) vs. those with CRP ≥8 = 5.09 (1.44, 18.02), and dual users with CRP &lt, 8 = 4.31 (2.35, 7.89) vs. those with CRP ≥8 = 7.37 (1.85, 29.41). These ORs indicate that depression is associated with each category of e-cigarette use, however, we found this association did not vary by systemic inflammation level (interaction p-values &gt, 0.05). Conclusion: While a pattern of greater ORs for depression among e-cigarette users with elevated CRP provides provocative findings that might suggest a potential role of inflammation in the association between vaping and depression, we failed to find evidence that inflammation clearly moderates this association. While it is possible that depression among e-cigarette users may be influenced by systemic inflammation, a reproduction of the current study is necessary among a larger cohort to elucidate the effect of inflammation on depression among e-cigarette users.

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

BACKGROUND: Tobacco use continues to be the leading cause of preventable death worldwide. OBJECTIVE: To assess perceived tobacco educational preparation of undergraduate and graduate nurses in a large urban university. DESIGN: A cross-sectional web-based survey of all nursing students in an urban college of nursing was conducted to assess perceived tobacco educational content, skills, and self-efficacy for cessation counseling with patients who smoke cigarettes and use alternative tobacco products (e.g., hookah and e-cigarettes). RESULTS: Participants reported the most education about health effects of tobacco use (67%), and less than 6% reported education about alternative tobacco products. While the majority of nurses agreed that advising patients to quit is a priority, less than 40% reported receiving sufficient training in cessation counseling. CONCLUSIONS: There continues to be a compelling need articulated by leaders in tobacco policy and research over the past decade for a more vigorous response by nurses to the tobacco epidemic.

Young adults are more likely to have experimented with electronic cigarettes (EC) and underestimate their risks. The on-line survey adapted from American Survey on Tobacco and Alternative Tobacco Products included questions about the personal use of EC, perceptions about the harms and their role in disease causation, education and cessation training and practices related to classical cigarettes (CC), electronic cigarettes (EC) and alternative tobacco products (ATP). The questionnaire filled in 577 medical students (71.9% women) from Comenius University in Bratislava, the average age was 23±2yrs. The sample comprised of 486 (84.2%) Slovak and 91 (15.8%) foreign students; 385 were (66.7%) non-smokers, 111 (19.3%) ex-smokers and 81 (14 %) current smokers. EC currently use 13.5 % medical students, more males than females (22.2% vs 10.12%; OR 2.53, 95% CI 1.55−4.13), more foreign students than Slovak students (24.2% vs 11.52; OR 2.44, 95% CI 1.41−4.26), more smokers of classical cigarettes than non-smokers (46.9% vs 8.06%; OR 10.07, 95% CI 5.85−17.34). EC seems to be less harmful to 59.97 % students, mostly in the age groups ≤ 24 (61.76% vs 51.49%; OR 1.46, 95% CI 1.03−2.07), 41.25% of students consider EC to be less addictive, 55.6% think they do not get enough education on EC during their medical study. The results show the high consumption of tobacco products and the lack of knowledge and awareness among medical students.

IntroductionUse of alternative nicotine delivery systems, such as electronic cigarettes and hookahs, has increased dramatically in the USA, but limited research has been conducted on the secondhand effects of these products, especially in children. The objective of this study is to assess the cardiopulmonary effects of e-cigarette and hookah use in vaping and smoking adults, and in non-smoking/non-vaping adults and children exposed to secondhand particles and gases.Methods and analysisThis study uses a pre/post design, with four groups: two control groups (non-smoking/non-vaping and cigarette smoking) and two test groups (hookah smoking and e-cigarette vaping). Participants will be recruited by household, so that each home includes one smoking or vaping adult and one non-smoking/non-vaping adult and/or child (5–18 years). Non-smoking/non-vaping homes include an adult and child who do not smoke or vape and do not live with individuals who do. Air quality measures will be completed during a household smoking or vaping session (ambient air for non-smoking/non-vaping group), while cardiopulmonary measures and biological samples will be taken directly before and after the smoking/vaping session, and again 24 hours later, for all participants. Air quality measures include carbon monoxide, black carbon, particulate matter, trace elements, nicotine and carbonyls; cardiopulmonary measures include heart rate variability, blood pressure, pulmonary function and exhaled carbon monoxide; biological samples will assess cotinine, inflammatory cytokines and biomarkers in urine, saliva and nasal mucosa.Ethics and disseminationThis study was approved by the Institutional Review Board at New York University School of Medicine (s16-02226 and s17-01143). Special attention was given to the inclusion of children, who are likely significantly impacted by the use of these products at home, and thus should be included in research. Results of the study will be distributed at conferences, in peer-reviewed journals and to relevant public health authorities for use in developing policy.

Background: Exposure to ETS (environmental tobacco smoke) is one of the most toxic environmental exposures. Objective: To investigate the association of ETS with physiological, biochemical, and psychological indicators, as well as with urine antioxidant capacity (AC) and oxidative damage to lipids in a pilot sample of healthy pregnant women. Methods: Exposure to ETS was investigated via a validated questionnaire, and urine cotinine and the marker of oxidative damage to lipids via 8-isoprostane concentrations using an ELISA kit. Urine AC was determined by the spectrophotometric Trolox-equivalent antioxidant capacity (TEAC) method. From a sample of pregnant women (n = 319, average age 30.84 &plusmn, 5.09 years) in 80, the levels of cotinine and oxidative stress markers were analyzed. Results: Among the 80 pregnant women, 5% (7.4% confirmed by cotinine) reported being current smokers and 25% reported passive smoking in the household (18.8% confirmed by cotinine). The Kappa was 0.78 for smokers and 0.22 for ETS-exposed nonsmokers. Pregnant women in the ETS-exposed group had significantly reduced AC compared to both the nonsmoker (ETS&minus, ) and the smoker groups (p &lt, 0.05). Nonsmokers had significantly lower levels of 8-isoprostane than smokers (p &lt, 0.01) and ETS-exposed nonsmokers (p &lt, 0.05). Correlations between urine levels of cotinine and AC were positive in ETS-exposed nonsmokers. Conclusion: A harmful association of active and passive smoking and oxidative stress parameters among pregnant women has been indicated.

Introduction Hookahs (water pipes) are rapidly increasing in popularity worldwide. Evidence suggests that although perceived as safer than cigarette smoke, hookah smoke may be as, or even more, dangerous as cigarette smoke. Methods Air samples from 33 homes—11 where only hookah-smoking occurred, 12 with only cigarettes and 10 with no smoking—were collected to analyse concentrations of particulate matter (PM 2.5 ), black carbon, elemental and organic carbon and carbon monoxide (CO). Air quality was assessed in rooms where smoking occurred and in an adjacent room. Results Hookah and cigarette smoking impaired home air quality. The rooms in which hookahs were smoked showed the highest concentrations for all pollutants. CO was significantly greater in the rooms where hookahs were smoked than in the cigarette-smoking rooms and the non-smoking households (p 2.5 levels were also elevated in hookah homes compared to cigarette and non-smoking homes, although not significantly different. Conclusions This study, the first of its kind, demonstrates potentially hazardous levels of home air pollution in rooms where hookahs are being smoked as well as in adjacent rooms. These levels were greater than those in cigarette smoking homes, raising concerns about potential negative health effects on all individuals living in homes where hookahs are smoked.

1. Nan Jiang, PhD* 2. Lily Lee†,§ 3. Judith T. Zelikoff, PhD‡ 4. Michael Weitzman, MD†,‡,¶,** 1. *Department of Population Health, 2. †Department of Pediatrics, 3. ‡Department of Environmental Medicine, School of Medicine, New York University, New York, NY 4. ¶College of Global Public Health, New York University, New York, NY 5. §Brooklyn College, Brooklyn, NY 6. **NYU Abu Dhabi Public Health Research Center, Abu Dhabi, United Arab Emirates 1. 1. Lauterstein D, 2. Hoshino R, 3. Gordon T, 4. Watkins BX, 5. Weitzman M, 6. Zelikoff J The Changing Face of Tobacco Use Among United States Youth. Lauterstein D, Hoshino R, Gordon T, Watkins BX, Weitzman M, Zelikoff J. Curr Drug Abuse Rev. 2014;7(1):29–43 [OpenUrl][1][CrossRef][2][PubMed][3] 2. 1. Nguyen KH, 2. Tong VT, 3. Marynak KL, 4. King BA US Adults' Perceptions of the Harmful Effects during Pregnancy of Using Electronic Vapor Products Versus Smoking Cigarettes, Styles Survey, 2015. Nguyen KH, Tong VT, Marynak KL, King BA. Prev Chronic Dis. 2016;13:E175 [OpenUrl][4] 3. 1. McGrath-Morrow SA, 2. Hayashi M, 3. Aherrera A, 4. et al. The Effects of Electronic Cigarette Emissions on Systemic Cotinine Levels, Weight and Postnatal Lung Growth in Neonatal Mice. McGrath-Morrow SA, Hayashi M, Aherrera A, et al. PLoS One. 2015;10(2):e0118344 [OpenUrl][5][CrossRef][6][PubMed][7] The emergence of electronic cigarettes (e-cigarettes) as devices touted to be helpful in the cessation or reduction of smoking has prompted many concerns about the prevalence and consequences of their use during pregnancy. Both pregnant women and health-care providers are poorly informed or misinformed about the potential health risks associated with e-cigarettes, which has profound consequences on clinical conversations about the product. Unfortunately, the scientific literature has not yet caught up with the rise in e-cigarette use. The safety of e-cigarettes to the mother and fetus is largely unknown, with a handful of human studies finding minimal health effects. In large part, concerns about e-cigarettes have been the result of the adverse health effects associated with nicotine during pregnancy, which include low birthweight, abnormal corpus callosum, and alterations in appetite, attention, and cognition. Although the health consequences of e-cigarette use during pregnancy remain poorly understood, it is imperative that health-care providers are well equipped to initiate conversations about e-cigarette use with pregnant women and women of childbearing age to discourage use during pregnancy as an aid to quitting smoking. E-cigarettes are the most commonly used, newly developed electronic nicotine delivery systems. They are battery-powered vaporizers that heat a liquid solution (typically containing nicotine, glycerol, propylene glycol, flavorings, and other additives) to deliver an aerosol for user inhalation with the intention of imitating conventional cigarettes. Since their introduction to the US market in 2007, e-cigarette use has increased rapidly among youths and adults. E-cigarettes are widely advertised and often are promoted as less harmful alternatives to cigarettes and also as effective smoking cessation tools, which has considerable … [1]: {openurl}?query=rft.jtitle%253DCurr%2BDrug%2BAbuse%2BRev%26rft.volume%253D7%26rft.spage%253D29%26rft_id%253Dinfo%253Adoi%252F10.2174%252F1874473707666141015220110%26rft_id%253Dinfo%253Apmid%252F25323124%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.2174/1874473707666141015220110&link_type=DOI [3]: /lookup/external-ref?access_num=25323124&link_type=MED&atom=%2Fpedsinreview%2F39%2F3%2F156.atom [4]: {openurl}?query=rft.jtitle%253DPrev%2BChronic%2BDis%26rft.volume%253D13%26rft.spage%253DE175%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [5]: {openurl}?query=rft.jtitle%253DPLoS%2BOne%26rft.volume%253D10%26rft.spage%253De0118344%26rft_id%253Dinfo%253Adoi%252F10.1371%252Fjournal.pone.0118344%26rft_id%253Dinfo%253Apmid%252F25706869%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: /lookup/external-ref?access_num=10.1371/journal.pone.0118344&link_type=DOI [7]: /lookup/external-ref?access_num=25706869&link_type=MED&atom=%2Fpedsinreview%2F39%2F3%2F156.atom

Background: Exposure to ETS (Environmental Tobacco Smoke) is one of the most toxic environmental exposures. Objective: To investigate the impact of ETS on physiological, biochemical, psychological indicators, on the urine antioxidant capacity (AC) and oxidative damage to lipids in a pilot sample of healthy pregnant women. Methods: The exposure to ETS was investigated by a validated questionnaire, urine cotinine and the marker of oxidative damage to lipids - 8-isoprostane concentrations using an ELISA kit. Urine AC was determined by the spectrophotometric TEAC method. From the sample of pregnant women (n=319, average age 30.84 ± 5.09 years) in 80 the levels of cotinine and oxidative stress markers were analyzed. Results: From our sample, 5 % individuals (7.4 % objectified by cotinine) were current smokers and 25 % reported passive smoking in the household (18.8 % objectified by cotinine). The Kappa was 0.78 for smokers and 0.22 for ETS exposed non-smokers. Smokers as well as non-smokers had significantly higher (p

IntroductionNon-cigarette tobacco products are an increasing public health concern globally. Little is known about midwakh, a pipe indigenous to the United Arab Emirates (UAE). This study aimed to assess the prevalence, attitudes, behaviours and policy evaluation of midwakh smoking among 13 to 15 year olds in the UAE.MethodsWe conducted secondary analyses of the 2013 UAE Global Youth Tobacco Survey. The main three outcomes were ever use, current use (past-30 days), and the number of midwakhs smoked per day. We assessed cessation, attitude, and policy measures. Regression models identified the association between each outcome measure and sex, school grade, nationality, weekly spending money, cigarette use, and parent and peer tobacco use.ResultsThe prevalence of ever and current midwakh use were 18.5% and 9.0%, respectively. Daily midwakh users smoked a median of 8.0 per day while non-daily users smoked 3.8 per month. Higher midwakh prevalence was reported among wealthier males, older age groups, concurrent cigarette users and among participants having peers or parents who use tobacco. There was also variation by nationality. Reduced harm perception was greater among midwakh users than non-users. About 39.6% reported being declined a midwakh purchase due to age, and 35.5% reported noticing health warnings on packages.ConclusionsMidwakh use is prevalent among 13 to 15 year olds in the UAE, and burden lies mainly with daily users. Further needed research should not delay implementation and evaluation of policies known to curb tobacco use among youth, including taxation, media campaigns, and provision of cessation services.

ETS exposure has been shown as an important environmental risk factor in vulnerable population groups. The aim of the project is to analyze the relationships among the ETS and behavior and health in 6−15-year-old children in Slovakia. The status of physical and mental health of children in relation to exposure to tobacco smoke was examined in the representative group of 1478 school children. The methods used, included anonymous questionnaires filled in by parents, Columbia Impairment Scale (CIS), Behavior Problem Index (BPI) and anthropometry. The prevalence of passive smoking is the highest in the capital (27%) and southern cities. Significant relationships have been confirmed between ETS and the age, socio-economic status, the incompleteness of the family, the level of mother's education and the significantly higher prevalence of respiratory diseases (26.7%).The relationships of ETS with emotional (CIS scores ≥16) and behavioral functions (BPI score ≥14) were significant in children exposed to mother‘s and father‘s smoking at home. In the multivariate analysis this association was not significant; the factors such as income and completeness of the family were dominant. The results confirmed the impact of ETS and social factors on health state and health behavior and could be the argumentation for legislative changes.

Nurses and other healthcare providers play key roles in screening and smoking cessation for their patients. However, studies have shown that providers who themselves smoke are less likely to assess and counsel their patients about smoking cessation (Braun et al. 2004; Sarna, Brown, Lillington, Wewers, & Brecht, 2000; Ulbricht et al., 2008). A report analyzing data from the U.S. National Tobacco Use Supplement comparing smoking rates in healthcare professionals from 2003 to 2010- 2011 demonstrated continued declines among physicians to 1% and registered nurses to 7% (Sarna, Bialous, Nandy, Antonio, & Yang, 2014). These rates are significantly lower than the general population rate of 18.1%. Healthcare providers as a group have among the lowest rates of smoking in the United States. An international review of tobacco smoking among nurses revealed an overall pattern of smoking reduction since the 1970s, with higher rates in some developing countries. However, there were considerable inconsistencies in developed countries, with some reporting rates significantly higher than those in the United States. Asian countries generally had lower rates for female nurses, who are culturally less inclined to smoke (Smith & Leggat, 2007).Though rates of cigarette smoking in the United States have declined dramatically over the past several decades, the Centers for Disease Control and Prevention (CDC) recently warned that the rise in use of alternative tobacco products (ATPs) may undercut the success of efforts to decrease cigarette consumption (CDC, 2012a). For example, recent studies of U.S. college and university students have showen that 40% to 54% have used ATPs during their lifetimes (Cobb, Ward, Maziak, Shihadeh, & Eissenberg, 2010; Primack et al., 2008; Rahman, Chang, Hadgu, Salinas-Miranda, & Corvin, 2014). Little is known about use of these products by healthcare providers. Reports of ATP use among international medical students have found rates of up to 20% (Nawaz, et al. 2007; Senkubuge, Ayo-Yusuf, Louwagie, & Okuyemi, 2012). A recent study conducted with medical students in an urban U.S. medical center found that about 4% reported current cigarette use, 4.8% currently used ATPs, and 51.7% reported lifetime use of ATPs. Students in the study consistently estimated cigarettes to be more harmful that ATPs despite the absence of research evidence comparing the two (Zhou et al., 2015). No studies of nurses' use of ATPs have been published to date.The most common ATPs used today are hookahs, electronic cigarettes (e-cigarettes), cigars, and cigarillos. Hookah, also known as waterpipe and narghile, is an alternative nicotine delivery system to cigarettes in which shisha (tobacco or nontobacco combustible materials) is smoked. The shisha is heated in a bowl of charcoal that is ignited to create smoke. Smoke from the bowl is drawn through a tube that passes through a water jar that cools and humidifies the smoke (American Lung Association, 2007). In contrast, e-cigarettes, which resemble tobacco cigarettes, do not contain any tobacco but do deliver nicotine that has been vaporized electronically to simulate tobacco smoke (Caponnetto, Campagna, Papale, Rosso, & Polosa, 2012). Smokeless tobacco, also called chewing and spit tobacco, is a less commonly used ATP. Bidis and kreteks are small rolled cigarettes containing tobacco, cloves, and sometimes flavors. While the prevalence of bidi and kretek use in the United States is low compared to other ATPs, they contain more nicotine, tar, and carbon monoxide than conventional cigarettes and are therefore more injurious to the health of smokers (Watson, Polzin, Calafat, & Ashley, 2003).The health effects of all ATPs are understudied. A systematic review of 24 studies conducted by Akl and colleagues (2010) concluded that hookah smoking was associated with increased risks for lung cancer, respiratory disease, and low birth weight. These studies, however, had some methodological limitations, and more rigorous studies are needed. …

Background Despite the increasing popularity of hookah bars, there is a lack of research assessing the health effects of hookah smoke among employees. This study investigated indoor air quality in hookah bars and the health effects of secondhand hookah smoke on hookah bar workers. Methods Air samples were collected during the work shift of 10 workers in hookah bars in New York City (NYC). Air measurements of fine particulate matter (PM 2.5 ), fine black carbon (BC 2.5 ), carbon monoxide (CO), and nicotine were collected during each work shift. Blood pressure and heart rate, markers of active smoking and secondhand smoke exposure (exhaled CO and saliva cotinine levels), and selected inflammatory cytokines in blood (ineterleukin (IL)-1b, IL-6, IL-8, interferon γ (IFN-γ), tumour necrosis factor (TNF-α)) were assessed in workers immediately prior to and immediately after their work shift. Results The PM 2.5 (gravimetric) and BC 2.5 concentrations in indoor air varied greatly among the work shifts with mean levels of 363.8 µg/m 3 and 2.2 µg/m 3 , respectively. The mean CO level was 12.9 ppm with a peak value of 22.5 ppm CO observed in one hookah bar. While heart rate was elevated by 6 bpm after occupational exposure, this change was not statistically significant. Levels of inflammatory cytokines in blood were all increased at postshift compared to preshift testing with IFN-Υ increasing from 0.85 (0.13) to 1.6 (0.25) (mean (standard error of the mean; SEM)) pg/mL (p 90 ppm exhaled CO. Conclusions These results demonstrate that hookah bars have elevated concentrations of indoor air pollutants that appear to cause adverse health effects in employees. These data indicate the need for further research and a marked need for better air quality monitoring and policies in such establishments to improve the indoor air quality for workers and patrons.

Few studies have assessed which biomarkers influence mortality risk among those with peripheral arterial disease (PAD). We analyzed data from 556 individuals identified to have PAD (i.e. ankle–brachial index ⩽0.9) with available measurements of C-reactive protein, the neutrophil-to-lymphocyte ratio (NLR), homocysteine, and the urinary albumin-to-creatinine ratio (UACR) in the 1999–2004 National Health and Nutrition Examination Survey. We investigated whether a combination of these biomarkers improved the prediction of all-cause and cardiovascular mortality beyond conventional risk factors. During follow-up (median, 8.1 years), 277 of 556 participants died; 63 deaths were attributed to cardiovascular disease. After adjusting for conventional risk factors, Cox proportional-hazards models showed the following to be most strongly associated with all-cause mortality (each is followed by the adjusted hazard ratio [HR] per 1 standard deviation increment in the log values): homocysteine (1.31), UACR (1.21), and NLR (1.20). UACR alone significantly predicted cardiovascular mortality (1.53). Persons in the highest quintile of multimarker scores derived from regression coefficients of significant biomarkers had elevated risks of all-cause mortality (adjusted HR, 2.45; 95% CI, 1.66–3.62; p for trend

Background In light of the current sentencing disparity (18:1) between crack and powder cocaine possession in the United States, we examined socioeconomic correlates of use of each, and relations between use and arrest, to determine who may be at highest risk for arrest and imprisonment. Methods We conducted secondary data analyses on the National Survey on Drug Use and Health, 2009–2012. Data were analyzed for adults age ≥18 to determine associations between use and arrest. Socioeconomic correlates of lifetime and annual use of powder cocaine and of crack were delineated using multivariable logistic regression and correlates of frequency of recent use were examined using generalized negative binomial regression. Results Crack users were at higher risk than powder cocaine users for reporting a lifetime arrest or multiple recent arrests. Racial minorities were at low risk for powder cocaine use and Hispanics were at low risk for crack use. Blacks were at increased risk for lifetime and recent crack use, but not when controlling for other socioeconomic variables. However, blacks who did use either powder cocaine or crack tended to use at higher frequencies. Higher education and higher family income were negatively associated with crack use although these factors were sometimes risk factors for powder cocaine use. Conclusions Crack users are at higher risk of arrest and tend to be of lower socioeconomic status compared to powder cocaine users. These findings can inform US Congress as they review bills (e.g., The Smarter Sentencing Act), which would help eliminate cocaine-related sentencing disparities.

1. Lily Lee*,† 2. Jenni A. Shearston‡,§ 3. Michael Weitzman, MD*,‡ 1. *Department of Pediatrics, New York University School of Medicine, New York, NY. 2. ‡College of Global Public Health, New York University, New York, NY. 3. †Brooklyn College, City University of New York, New York, NY. 4. §Department of Population Health, New York University School of Medicine, New York, NY. 1. 1. Drummond MB, 2. Upson D Electronic Cigarettes: Potential Harms and Benefits. Drummond MB, Upson D. Ann Am Thorac Soc. 2014;11(2):236–242. doi: 10.1513/AnnalsATS.201311-391FR. [OpenUrl][1][CrossRef][2][PubMed][3] 2. 1. Lauterstein D, 2. Hoshino R, 3. Gordon T, 4. Watkins B, 5. Weitzman M, 6. Zelikoff J The Changing Face of Tobacco Use Among United States Youth. Lauterstein D, Hoshino R, Gordon T, Watkins B, Weitzman M, Zelikoff J. Curr Drug Abuse Rev. 2014;7(1): 29–43. [OpenUrl][4][CrossRef][5][PubMed][6] 3. 1. Maziak W, 2. Jawad M, 3. Jawad S, 4. Ward KD, 5. Eissenberg T, 6. Asfar T Interventions for Waterpipe Smoking Cessation. Maziak W, Jawad M, Jawad S, Ward KD, Eissenberg T, Asfar T. Cochrane Database Syst Rev. 2015 Jul 31;7:CD005549. doi: 0.1002/14651858.CD005549.pub3. Almost all cigarette use in the United States begins during adolescence, and about 3 of every 4 adolescent smokers continue to smoke into adulthood. Although overall cigarette consumption in the United States has decreased by 33% in the last decade, overall tobacco use among middle and high school students has demonstrated little to no decline. The United States has witnessed an increase in the use of new, so-called alternative tobacco products (ATPs). The many types of ATPs vary from the more popular smoked products such as electronic cigarettes (e-cigarettes) and hookahs (also known as water-pipes or narghile) to smokeless products such as snus. These ATPs are believed by the public and adolescents to be less harmful, less addictive, and more stylish than cigarettes. They are being promoted as and perceived by adolescents, the general public, and health care clinicians as safer alternatives to traditional cigarettes. Many in the public health community fear that, in the absence of widespread awareness and regulatory policies, ATPs will encourage adolescents to start smoking and, thus, undermine a decades-long campaign to “denormalize” smoking. Rates of past 30-day use of e-cigarettes among middle and high school students tripled from 2013 to 2014, after doubling the year before. From 2010 to 2014, the percentage of high school seniors who used hookahs in the last year increased from 17% to 23%. In 2014, for the first time, e-cigarettes were reported to be the most commonly used tobacco product by high school students (13.4%), ahead of both hookahs … [1]: {openurl}?query=rft.jtitle%253DAnn%2BAm%2BThorac%2BSoc%26rft.volume%253D11%26rft.spage%253D236%26rft_id%253Dinfo%253Adoi%252F10.1513%252FAnnalsATS.201311-391FR%26rft_id%253Dinfo%253Apmid%252F24575993%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1513/AnnalsATS.201311-391FR&link_type=DOI [3]: /lookup/external-ref?access_num=24575993&link_type=MED&atom=%2Fpedsinreview%2F37%2F7%2F310.atom [4]: {openurl}?query=rft.jtitle%253DCurr%2BDrug%2BAbuse%2BRev%26rft.volume%253D7%26rft.spage%253D29%26rft_id%253Dinfo%253Adoi%252F10.2174%252F1874473707666141015220110%26rft_id%253Dinfo%253Apmid%252F25323124%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [5]: /lookup/external-ref?access_num=10.2174/1874473707666141015220110&link_type=DOI [6]: /lookup/external-ref?access_num=25323124&link_type=MED&atom=%2Fpedsinreview%2F37%2F7%2F310.atom

Objective To examine the association between state-level tobacco control measures and current use estimates of both e-cigarettes and cigarettes, while accounting for socio-demographic correlates. Methods Using the 2012-2013 and 2013-2014 National Adult Tobacco Survey (NATS), we assessed prevalence estimates of US adults' e-cigarette and cigarette current use. Four state groups were created based on the combined state-specific prevalence of both products: low cigarette/e-cigarette (n = 15), high cigarette/e-cigarette (n = 16), high cigarette/low e-cigarette (n = 11), and low cigarette/high e-cigarette) (n = 9). To evaluate the implementation of state-level tobacco control measures, Tobacco Control Index (TCI) was calculated using the State of Tobacco Control annual reports for 2012 and 2013. Multinomial logistic regression models were used to examine differences among the four groups on socio-demographic factors and TCI. Low cigarette/e-cigarette group was used as the referent group. Results Current use estimates of each product varied substantially by state; current e-cigarette use was highest in Oklahoma (10.3%) and lowest in Delaware (2.7%), and current cigarette use was highest in West Virginia (26.1%), and lowest in Vermont (12.6%). Compared to low cigarette/e-cigarette, all other US-state categories had significantly lower TCI scores (high cigarette/e-cigarette: adjusted Relative Risk Ratio [aRRR] = 0.61; 95% confidence interval [CI]: 0.60-0.61, high cigarette/low e-cigarette: aRRR = 0.74; 95% CI: 0.73-0.74, and low cigarette/high e-cigarette: aRRR = 0.72; 95% CI: 0.71-073). Conclusions Enforcing existing tobacco control measures likely interacts with e-cigarette use despite being cigarette-focused. Continuing to monitor e-cigarette use is critical to establish baseline use and evaluate future e-cigarette specific federal and state-level tobacco regulatory actions while accounting for the existing tobacco control environment. Implications This study investigates state-level current use estimates of e-cigarettes and cigarettes among US adults; and their association with four existing tobacco control measures. The overall score of these measures was negatively associated with state-level current use estimates such that states with low current e-cigarette and cigarette use had the highest mean overall score. This study assesses the potential relationship between existing state-level tobacco control measures and e-cigarette use and calls for improving the enforcement of the known-to-work tobacco control measures across all US states, while developing evidence-based regulations and interventions specific to e-cigarettes within the existing US tobacco use environment.

Background Approximately one in 285 children will be diagnosed with cancer before reaching their 20th birthday. While both oncologists and parents report a preference that these children die at home rather than in a hospital, there are limited data exploring this issue in depth. Procedure We performed a retrospective analysis of national-level data from 1999 to 2011 from the National Center for Health Statistics “Underlying Cause of Death” database. Characteristics investigated included sex, race, age, ethnicity, cancer type, geographic location, and population density where the child lived. Results Of the 2,130 children with a death attributable to neoplasm in 2011, 37.6% (95% CI, 35.5–39.6%) died at home compared to 36.9% (95% CI, 35.0–38.8%) in 1999. In 2011, there were statistically significant racial differences between white, black, and Hispanic children across nearly every age group, with white children consistently most likely to die at home. Children of non-Hispanic origin were significantly more likely to die at home than Hispanic children (40.3% vs. 29.3%, P

BACKGROUND: Light smoking, consuming a few cigarettes daily, and intermittent, or nondaily, smoking patterns are increasingly common but carry health risks comparable to heavier smoking patterns. Nearly all smokers begin smoking as adolescents, who are at risk for developing these smoking patterns. Previous research suggests that smokers underestimate the risks associated with smoking. The extent to which adolescents perceive light and intermittent smoking as harmful has not been previously assessed. METHODS: Data from 24 658 US adolescents sampled by the 2012 National Youth Tobacco Survey, a national, school-based, cross-sectional survey, were examined. Cross-tabulations and multivariate ordered probit regression models were constructed to describe correlates of US adolescents’ perception of light and intermittent smoking. RESULTS: Although most adolescents (88.0%; 95% confidence interval [CI], 87.2% to 88.8%) reported beliefs that a heavier smoking pattern is very harmful, only 64.3% (95% CI; 63.2% to 65.3%) and 33.3% (95% CI; 32.0% to 34.6%) reported that light and intermittent smoking, respectively, are very harmful. Conversely, nearly one-quarter of US adolescents believed intermittent smoking causes little or no harm. Males, younger adolescents, Hispanics, and non-Hispanic blacks were more likely than their peers to view light and intermittent smoking patterns as less harmful. Those who were already light or intermittent smokers, those who used other tobacco products, and those who had a family member who used tobacco were also less likely to view their smoking patterns as harmful. CONCLUSIONS: Misconceptions about the safety of light and intermittent smoking are widespread among US adolescents. Significant public health attention is needed to redress these misperceptions.

Introduction Self-reported tobacco use in the United Arab Emirates is among the highest in the region. Use of tobacco products other than cigarettes is widespread, but little is known about specific behavior use patterns. There have been no studies that have biochemically verified smoking status. Methods The UAE Healthy Future Study (UAEHFS) seeks to understand the causes of non-communicable diseases through a 20,000-person cohort study. During the study pilot, 517 Emirati nationals were recruited to complete a questionnaire, provide clinical measurements and biological samples. Complete smoking data were available for 428 participants. Validation of smoking status via cotinine testing was conducted based on complete questionnaire data and matching urine samples for 399 participants, using a cut-off of 200ng/ml to indicate active smoking status. Results Self-reported tobacco use was 36% among men and 3% among women in the sample. However, biochemical verification of smoking status revealed that 42% men and 9% of women were positive for cotinine indicating possible recent tobacco use. Dual and poly-use of tobacco products was fairly common with 32% and 6% of the sample reporting respectively. Conclusions This is the first study in the region to biochemically verify tobacco use self-report data. Tobacco use in this study population was found to be higher than previously thought, especially among women. Misclassification of smoking status was more common than expected. Poly-tobacco use was also very common. Additional studies are needed to understand tobacco use behaviors and the extent to which people may be exposed to passive tobacco smoke. Implications This study is the first in the region to biochemically verify self-reported smoking status.

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.

This article summarizes the presentation of the 2017 Howland Award to Michael Weitzman, MD, at the Annual Pediatric Academic Society Meetings. It summarizes the remarkable advances in understanding the effects and pathways of exposure of the two most common and pernicious of our nation’s child environmental exposures, namely lead and tobacco. It also summarizes the profound effect of the translation of these findings into prudent and effective clinical and public health policies such that exposure to both has dramatically decreased over the past 40 years due to the tenacious activities of pediatricians, other child-related professionals, government agencies at all levels, and the American Academy of Pediatrics. Research and clinical activities, although essential, were not sufficient to produce these successes, but required extensive mentoring to produce a generation of academic pediatricians capable of conducting the requisite research, and extensive advocacy by pediatricians and others to overcome the formidable inertia and outright opposition to efforts to protect our children from these exposures. Moreover, the article highlights that both of these environmental exposures have roots in social and environmental injustice and neither is solved, and that there is no safe level of exposure to either of these toxicants.

Tobacco use among young people is increasing in the United Arab Emirates, and the country is ranked 15th in the world for prevalence of type II diabetes. Expatriates comprise a majority of the population, making them an important subset to study. We aimed to test whether an educational intervention would be effective in this cultural setting. We designed 2 peer-to-peer health workshops: tobacco use and nutrition/physical activity. One workshop was randomly assigned to 18 classrooms in private schools in Abu Dhabi. Surveys were administered before and after the workshops to assess intervention effectiveness. The tobacco workshop significantly improved responses (P0.05). The nutrition and physical activity workshop resulted in decreased satisfaction with personal activity levels. This study provides evidence to support the national adoption of a peer-to-peer health education model as an intervention for tobacco use but not for nutrition and physical activity choices.تنفيذ نموذج التعليم الصحي عن طريق الأقران في الإمارات العربية المتحدة: التصدِّي للسلوكيات الخطرة في صفوف المراهقن المغتربن.زاكري ستانلي، لينا عصفور، مايكل وايتزمان، سكوت شرمان.بدأ استخدام التبغ في التزايد في صفوف الشباب في دولة الإمارات العربية المتحدة، ويحتل البلد المرتبة الخامسة عرة عى مستوى العالم لانتشار النوع الثاني من داء السكّري. ويشكّل المغتربون أغلبية السكان، مما يجعلهم مجموعة فرعية مهمة للدراسة. واستهدفنا في هذه الدراسة اختبار مدى فعالية التدخات التعليمية في هذا الإطار الثقافي. فقمنا بتصميم حلقتَيْ عمل للأقران في المجال الصحي حول: استخدام التبغ، والتغذية/النشاط البدني. وخُصصت إحدى حلقتَيْ العمل بصورة عشوائية إلى 18 صفاً دراسياً في مدينة أبو ظبي. وأجريت مسوح قبل وبعد حلقتَيْ العمل لتقييم فعالية التدخُّل. وتمكَّنت حلقة العمل المعنية بالتبغ من تحسن الاستجابات عى نحو ملحوظ (0.05p). وأسفرت حلقة العمل المعنية بالتغذية والنشاط البدني عن انخفاض مستوى الرضا عن مستويات النشاط الشخصي. وتوفِّر هذه الدراسة الدليل لدعم اعتاد نموذج التعليم الصحي بن الأقران عى المستوى الوطني باعتباره تدخاً لمواجهة استخدام التبغ ولكن ليس لأغراض التغذية والاختيارات الخاصة بالنشاط البدني.Mise en oeuvre d’un modèle d’éducation en santé axé sur l'intervention des pairs aux Émirats arabes unis : lutter contre les comportements à risque des adolescents expatriés.La consommation de tabac parmi les jeunes est en augmentation aux Émirats arabes unis, et le pays se classe au quinzième rang mondial pour la prévalence du diabète de type 2. Les expatriés constituent une majorité de la population, ce qui fait d’eux un sous-ensemble important à étudier. Notre objectif consistait à déterminer si une intervention éducative serait efficace dans ce contexte culturel. Nous avons mis au point deux ateliers de santé organisés par des pairs et portant sur le tabagisme d’une part, et sur la nutrition et l’activité physique d’autre part. Dix-huit classes d’établissements privés à Abou Dhabi se sont vues attribuées l’un des deux ateliers thématiques susmentionnés. Des sondages ont été menés avant et après les ateliers afin d’évaluer l’efficacité de l’intervention. L’atelier sur le tabagisme a conduit à une amélioration significative des modifications de comportement (p0,05). L’atelier sur la nutrition et l’activité physique a permis une baisse de la satisfaction des participants concernant leurs niveaux personnels d’activité. Cette étude fournit des arguments en faveur de l’adoption d’un modèle d’éducation par les pairs comme intervention de lutte contre le tabagisme, mais pas pour les choix liés à la nutrition et l’activité physique.

Leptin and C-reactive protein (CRP) have each been linked to adverse cardiovascular events, and prior cross-sectional research suggests that increased levels of both biomarkers pose an even greater risk. The effect of increased levels of both leptin and CRP on mortality has not, however, been previously assessed.We used data from the third National Health and Nutrition Examination Survey (NHANES III) to estimate the mortality effect of high leptin and high CRP levels. Outcomes were compared with the use of inverse-probability-weighting adjustment. Among 6259 participants included in the analysis, 766 were in their sex-specific, population-weighted highest quartiles of both leptin and CRP. Median follow-up time was 14.3 years.There was no significant difference in adjusted all-cause mortality between the groups (risk ratio 1.22, 95% confidence interval [CI], 0.97-1.54). Similar results were noted with the use of several different analytic methods and in many subgroups, though high leptin and CRP levels may increase all-cause mortality in males (hazard ratio, 1.80, 95% CI, 1.32-2.46; P for interaction, 0.011). A significant difference in cardiovascular mortality was also noted (risk ratio, 1.54, 95% CI, 1.08-2.18), though that finding was not confirmed in all sensitivity analyses..In this observational study, no significant difference in overall all-cause mortality rates in those with high leptin and high CRP levels was found, though high leptin and CRP levels appear associated with increased mortality in males. High leptin and CRP levels also likely increase risk for cardiovascular death..