Longitudinal Assessments of Neurocognitive Performance and Brain Structure Associated with Initiation of Tobacco Use in Children, 2016 to 2021

Journal: JAMA Network Open, 2022, doi: 10.1001/jamanetworkopen.2022.25991

Authors: Hongying Daisy Dai, Gaelle E. Doucet, Yingying Wang, Troy Puga, Kaeli Samson, Peng Xiao & Ali S. Khan


Importance: The landscape of tobacco use is changing. However, information about the association between early-age tobacco use and cognitive performances is limited, especially for emerging tobacco products such as electronic cigarettes (e-cigarettes).

Objective: To assess the association between early-age initiation of tobacco use and cognitive performances measured by the National Institutes of Health (NIH) Toolbox Cognitive Battery and to examine whether initiation is associated with differences in brain morphometry.

Design, setting, and participants: This observational cohort study examined the longitudinal associations of initiation of tobacco use with neurocognition using multivariate linear mixed models. Children aged 9 to 10 years from 21 US sites were enrolled in wave 1 (October 1, 2016, to October 31, 2018 [n = 11 729]) and the 2-year follow-up (August 1, 2018, to January 31, 2021 [n = 10 081]) of the Adolescent Brain Cognitive Development (ABCD) Study.

Exposures: Ever use (vs none) of any tobacco products at wave 1, including e-cigarettes, cigarettes, cigars, smokeless tobacco, hookah, pipes, and nicotine replacement.

Main outcomes and measures: Neurocognition measured by the NIH Toolbox Cognition Battery and morphometric measures of brain structure and region of interest analysis for the cortex from structural magnetic resonance imaging.

Results: Among 11 729 participants at wave 1 (mean [SE] age, 9.9 [0.6] years; 47.9% girls and 52.1% boys; 20.3% Hispanic; 14.9% non-Hispanic Black; and 52.1% non-Hispanic White), 116 children reported ever use of tobacco products. Controlling for confounders, tobacco ever users vs nonusers exhibited lower scores in the Picture Vocabulary Tests at wave 1 (b [SE] = -2.9 [0.6]; P < .001) and 2-year follow-up (b [SE] = -3.0 [0.7]; P < .001). The crystalized cognition composite score was lower among tobacco ever users than nonusers both at wave 1 (b [SE] = -2.4 [0.5]; P < .001) and 2-year follow-up (b [SE] = -2.7 [0.8]; P = .005). In structural magnetic resonance imaging, the whole-brain measures in cortical area and volume were significantly lower among tobacco users than nonusers, including cortical area (b [SE] = -5014.8 [1739.8] mm2; P = .004) at wave 1 and cortical volume at wave 1 (b [SE] = -174 621.0 [5857.7] mm3; P = .003) and follow-up (b [SE] = -21 790.8 [7043.9] mm3; P = .002). Further region of interest analysis revealed smaller cortical area and volume in multiple regions across frontal, parietal, and temporal lobes at both waves.

Conclusions and relevance: In this cohort study, initiating tobacco use in late childhood was associated with inferior cognitive performance and reduced brain structure with sustained effects at 2-year follow-up. These findings suggest that youths vulnerable to e-cigarettes and tobacco products should be treated as a priority population in tobacco prevention.

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E-Cigarette Use and Intentions Related to Psychological Distress among Cigarette, E-Cigarette, and Cannabis Vape Users during the Start of the COVID-19 Pandemic

Journal: BMC Psychology, 2022, doi: 10.1186/s40359-022-00910-9

Author: Patricia Cabral


Background: This study examines associations between psychological distress, intentions to use e-cigarettes, and cigarette smoking, e-cigarette use, and cannabis consumption through e-cigarette use among a diverse sample of U.S. young adults.

Procedures: Young adults (N = 314; 72.5% female) were recruited to complete an online survey during the first few months of the COVID-19 pandemic.

Results: Associations between psychological distress and cigarette smoking, e-cigarette use, cannabis vaping, and intentions to use e-cigarettes were found. Current e-cigarette use (OR = 1.23, 95% CI 1.17, 1.28, p < .001; 7.5%) and cannabis vaping (OR = 2.03, 95% CI 1.88, 2.18, p < .001; 10%) was higher among female, possibly due to the significantly higher psychological distress reported among females. Interactions between intentions to use e-cigarettes and psychological distress variables were found for all smoking and vaping behaviors.

Conclusions: Public health efforts should increase focus on providing psychological services for young adults to improve coping strategies that are alternative to smoking and vaping behaviors.

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Hepatitis C Virus Risk among Young People who Inject Drugs

Journal: Front Public Health, 2022, doi: 10.3389/fpubh.2022.835836

Authors: Pedro Mateu-Gelabert, Nasim S. Sabounchi, Honoria Guarino, Courtney Ciervo, Kellie Joseph, Benjamin J. Eckhardt, Chunki Fong, Shashi N. Kapadia & Terry T. K. Huang


Background: Injection drug use (IDU) is the leading risk factor for hepatitis C virus (HCV) transmission in the U.S. While the general risk factors for HCV transmission are known, there is limited work on how these factors interact and impact young people who inject drugs (YPWID).

Methods: Project data were drawn from a study of 539 New York City (NYC) residents ages 18-29 who were recruited via Respondent-Driven Sampling and, reported past-month non-medical use of prescription opioids and/or heroin. Analyses are based on a subsample of 337 (62%) who reported injecting any drug in the past 12 months. All variables were assessed via self-report, except HCV status, which was established via rapid antibody testing. Integrating the observed statistical associations with extant literature on HCV risk, we also developed a qualitative system dynamics (SD) model to use as a supplemental data visualization tool to explore plausible pathways and interactions among key risk and protective factors for HCV.

Results: Results showed a 31% HCV antibody prevalence with an overall incidence of 10 per 100 person-years. HCV status was independently correlated with having shared cookers with two or more people (AOR = 2.17); injected drugs 4-6 years (AOR = 2.49) and 7 or more years (AOR = 4.95); lifetime homelessness (AOR = 2.52); and having been incarcerated two or more times (AOR = 1.99). These outcomes along with the extant literature on HCV risk were used to develop the qualitative SD model, which describes a causal hypothesis around non-linearities and feedback loop structures underlying the spread of HCV among YPWID.

Conclusions: Despite ongoing harm reduction efforts, close to a third of YPWID in the community sample have been exposed to HCV, have risks for injection drug use, and face challenges with structural factors that may be preventing adequate intervention. The qualitative SD model explores these issues and contributes to a better understanding of how these various risk factors interact and what policies could potentially be effective in reducing HCV infections.

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The Global Burden of Cancer Attributable to Risk Factors, 2010-19: A Systematic Analysis for the Global Burden of Disease Study 2019

Journal: The Lancet, 2022, doi: 10.1016/S0140-6736(22)01438-6

Authors: GBD 2019 Cancer Risk Factors Collaborators


Background: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally.

Methods: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented.

Findings: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01-4·94) deaths and 105 million (95·0-116) DALYs for both sexes combined, representing 44·4% (41·3-48·4) of all cancer deaths and 42·0% (39·1-45·6) of all DALYs. There were 2·88 million (2·60-3·18) risk-attributable cancer deaths in males (50·6% [47·8-54·1] of all male cancer deaths) and 1·58 million (1·36-1·84) risk-attributable cancer deaths in females (36·3% [32·5-41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6-28·4) and DALYs by 16·8% (8·8-25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9-42·8] and 33·3% [25·8-42·0]).

Interpretation: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden.

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The Measurement of Dose and Response for Smoking Behavior Change Interventions in the Digital Age: Systematic Review

Journal: Journal of Medical Internet Research, 2022, doi: 10.2196/38470

Authors: Megumi Ichimiya, Raquel Gerard, Sarah Mills, Alexa Brodsky, Jennifer Cantrell & W. Douglas Evans


Background: There is little consensus regarding effective digital health interventions for diverse populations, which is due in part to the difficulty of quantifying the impact of various media and content and the lack of consensus on evaluating dosage and outcomes. In particular, digital smoking behavior change intervention is an area where consistency of measurement has been a challenge because of emerging products and rapid policy changes. This study reviewed the contents and outcomes of digital smoking interventions and the consistency of reporting to inform future research.

Objective: This study aims to systematically review digital smoking behavior change interventions and evaluate the consistency in measuring and reporting intervention contents, channels, and dose and response outcomes.

Methods: PubMed, Embase, Scopus, PsycINFO, and PAIS databases were used to search the literature between January and May 2021. General and journal-based searches were combined. All records were imported into Covidence systematic review software (Veritas Health Innovation) and duplicates were removed. Titles and abstracts were screened by 4 trained reviewers to identify eligible full-text literature. The data synthesis scheme was designed based on the concept that exposure to digital interventions can be divided into intended doses that were planned by the intervention and enacted doses that were completed by participants. The intended dose comprised the frequency and length of the interventions, and the enacted dose was assessed as the engagement. Response measures were assessed for behaviors, intentions, and psychosocial outcomes. Measurements of the dose-response relationship were reviewed for all studies.

Results: A total of 2916 articles were identified through a database search. Of these 2916 articles, the title and abstract review yielded 324 (11.11%) articles for possible eligibility, and 19 (0.65%) articles on digital smoking behavior change interventions were ultimately included for data extraction and synthesis. The analysis revealed a lack of prevention studies (0/19, 0%) and dose-response studies (3/19, 16%). Of the 19 studies, 6 (32%) reported multiple behavioral measures, and 5 (23%) reported multiple psychosocial measures as outcomes. For dosage measures, 37% (7/19) of studies used frequency of exposure, and 21% (4/19) of studies mentioned the length of exposure. The assessment of clarity of reporting revealed that the duration of intervention and data collection tended to be reported vaguely in the literature.

Conclusions: This review revealed a lack of studies assessing the effects of digital media interventions on smoking outcomes. Data synthesis showed that measurement and reporting were inconsistent across studies, illustrating current challenges in this field. Although most studies focused on reporting outcomes, the measurement of exposure, including intended and enacted doses, was unclear in a large proportion of studies. Clear and consistent reporting of both outcomes and exposures is needed to develop further evidence in intervention research on digital smoking behavior change.

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