Objective: To explore the role of interprofessional collaboration in the delivery of team-based tobacco dependence treatments within primary care. Methods: A narrative review of the literature was completed to examine FHT team functioning in Ontario, followed by a single, multi-site qualitative exploratory case study. Results: Interprofessional collaboration contributed to changes in tobacco dependence treatment through the initiation of system-wide change, cultivation of collective action, and supporting enhanced quality of smoking cessation care. Conclusion: Interprofessional collaboration can enhance the comprehensive delivery of evidence-based treatments for individuals trying to quit smoking. Supportive public policy, education for patients and providers, and evaluation research is needed to advance FHT functioning.

Background: The health effects of sheesha smoking are not well addressed. Objective: To assess the association between sheesha tobacco smoking and gene expression pertinent to cancer. Methodology: Three linked studies were carried out: (1) investigation of gene expression in salivary cells before and after exposure to sheesha tobacco smoke in 15 participants; (2) a systematic review of the association between sheesha and cancer; and (3) a pilot survey to collect data on factors potentially relevant to the uptake and cessation of sheesha tobacco smoking. Results: In the short-term, sheesha smoking significantly reduced the expression of both xenobiotic metabolism genes and other genes known to have altered expression in tobacco related cancers in a range between 1.7 times and 55 times. The systematic review showed that sheesha may increase the risk of lung and esophageal cancers. The pilot survey identified misperceptions about safety, in line with other studies, an approach that could be used to investigate the characteristics of sheesha smokers on a larger scale, and specific issues to probe. Conclusion: High quality epidemiological evidence on long-term effects of sheesha smoking on cancer is lacking. However, sheesha smoking has short-term effects on the expression of genes known to be involved in tobacco-related cancers. This is of major concern given widespread misperceptions about the likely safety of sheesha tobacco smoking.

Mortality related to smoking continues to be one of the foremost preventable public health issues. Smoking amongst sexual minorities (those who have a sexual attraction to or sexual contact with people of the same sex and/or of both sexes or a sexual identity of gay/lesbian or bisexual) remains significantly greater than the general population and those with only opposite sex attractions or sexual contacts. While smoking prevalence has dropped since the late 1990's in the general population, smoking among sexual minorities remains disproportionately greater than heterosexuals. Methods: A secondary data analysis was completed using two United States data sets: the 2013 Youth Risk Behavior Survey (YRBS) and the first wave of the National Longitudinal Study of Adolescent to Adult Health (Add Health) dataset collected in 1994. The analyses focused on high school students, grades 9-12. The purpose was two-fold. First, the goal was to develop a profile of smoking indicators in sexual minority youth in the 1994 Add Health dataset and in the 2013 YRBS dataset. Profiles include six smoking-related indicators: 1) ever smoked; 2) age of first cigarette smoked; 3) current smoking; 4) frequent smoking; 5) daily smoking; and 6) attempts to quit smoking. Second, the goal was to compare sexual minority youth to their heterosexual peers within each data set to identify the scope of any disparities in smoking behaviors. Results: Disparities in smoking behaviors were found in both comparisons between the heterosexual and sexual minority youth. Prevalence of all smoking behaviors was greater for sexual minority youth in both data sets. The smoking disparities were greater in the sexual minority youth in the 2013 YRBS sample. Between the 1994 Add Health and 2013 YRBS samples, smoking behaviors in sexual minority youth showed a decrease in all smoking behaviors, but not as significant as their heterosexual peers. Youth who are attracted to both sexes or identify as bisexual consistently have a greater prevalence in smoking behaviors.Conclusion: A growing disparity exists between sexual minority youth and their heterosexual peers related to smoking behaviors. Public health policy and programming needs to focus on earlier prevention efforts related to psycho-sexual development with targeted policy and curriculum around the adoption of negative health behaviors in sexual minority youth, especially those who have both sex attractions, have sexual contact with both sexes or identify as bisexual.

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No description available.

Purpose: The purpose of this research program was three-fold. First it aimed to determine the effectiveness of smoking cessation interventions in increasing cessation rates in smokers with cerebrovascular disease and whether smoking cessation reduces stroke recurrence. Second it aimed to determine the prognostic influence of smoking and its association with stroke severity, disability, length of stay in hospital and mortality. Third it aimed to identify multi-level correlates of smoking cessation in Canadians who reported stroke symptoms in a large population based survey. Methods: Two systematic reviews and meta-analyses were performed to achieve the first objective. For the second objective, a retrospective cohort study was undertaken using variables from the Registry of the Canadian Stroke Network. Finally, the third objective was achieved by analyzing respondents from the Canadian Community Health Survey. Results: There is a paucity of intervention studies examining the effectiveness of smoking cessation in smokers with cerebrovascular disease. Most intervention studies that were found, failed to employ evidence-based approaches to smoking cessation. No evidence was found in regards to the effect of smoking cessation on stroke recurrence. We found smokers had strokes at a younger age compared to non-smokers. We found that in transient ischemic attacks and intracerbral haemorrhage, smoking was a significant predictor of stroke severity, disability, length of stay in hospital and 1 year mortality. Correlates of smoking cessation among Canadians who have experienced symptoms of a stroke included: higher education and income, implementation of household and vehicle smoking restrictions, access to a general practitioner and the use of smoking cessation pharmacotherapies and counselling support. Co-morbidities such as depression and alcohol consumption reduced the likelihood of successful cessation. Conclusions: This three-phase research program elucidated the gaps in intervention research for this population along with co-morbidities that hinder success in cessation. Smoking negatively impacted outcomes such as disability, hospital length of stay and mortality in patients with transient ischemic attacks and intracerebral haemorrhage strokes. Future interventions should take into account modifiable smoking cessation correlates in order to increase cessation rates in smokers with cerebrovascular disease.

La Chicha qui sert à fumer du tabac parfumé est utilisé par des millions de personnes. Il y a peu de données sur les effets du chicha sur la santé, peu de régulation et les utilisateurs pensent que la chicha n’est ni addictif ni nocif. Nous avons émis l’hypothèse que la consommation même occasionnelle de la chicha chez le sujet jeune a des conséquences sur la biologie pulmonaire. Nous avons ainsi comparé 21 sujets jeunes fumeur occasionnel de Chicha à un groupe de 19 non fumeur apparié pour le sexe et l’ethnicité. Les premières anomalies chez le fumeur de cigarette étant présent au niveau des cellules pulmonaires nous avons évalué plusieurs paramètres : (1) taux plasmatique de carboxyhemoglobine (CO), (2) Score de toux et d’expectoration; (3) fonction pulmonaire; (4) Métabolites présent dans les fluides des voies respiratoires basses (ELF); (5différences cellulaires et de transcriptome des petites voies aériennes (6) composition cellulaire des lavages broncho-alvéolaires (7) le transcriptome et (9) niveau des microparticules endothéliales circulantes. Le groupe d’étude montrait des anomalies dans tous les paramètres étudiés. Comparé au groupe contrôle les fumeurs avaient plus de toux et d’expectoration, un niveau de CO plus élevé, une diminution de la capacité de diffusion du CO , des anomalies du profil métabolique des fluides alvéolaires, une augmentation des cellules sécrétoires et intermédiaires et une diminution des cellules ciliées et basales, des anomalies du transcriptome des cellules pulmonaires et de macrophages alvéolaires et une augmentation des microparticules endothéliales.LA capacité de diffusion du monoxyde de carbone qui est un paramètre lié à l’emphysème et aux pathologies des petites voies pulmonaires était affectée par l’utilisation de la chicha. Nos précédentes études avaient montré que chez les sujets fumeurs de cigarette la réduction de la capacité de diffusion malgré une spirométrie normale était associée à un risque de développer un BPCO. Nous avons ainsi évalué le risque de développer une BPCO chez le sujet fumeur avec spirométrie normale par des scanners haute résolution comparant des groupes avec capacité de diffusion diminuée (46) et normale (59). La réduction de la capacité de diffusion était associée à un risque élevé de développer une BPCO dans les 4 ans.Par ailleurs les niveaux plasmatiques des microparticules endothéliales totales et apoptotiques était élevé dans le groupe d’étude. Dans une étude chez les sujets fumeurs de cigarette, nous avons comparé des non fumeurs (28) à des fumeurs sains (61) et des fumeurs BPCO (49) sur un an. Nous avons montré que le niveau de microparticules endothéliales apoptotiques étaient élevé en continu chez les sujets fumeurs sains et avec BPCO. Un sous groupe des fumeurs sains (17) et BPCO (18) a accepté d’arrêter de fumer. 12 mois après l’arrêt de la cigarette le niveau des microparticules endothéliales totale et apoptotique était retourné à la normale pour les fumeurs sains mais restait élevé chez les fumeurs BPCO. Ainsi le niveau élevé de ces microparticules indiquait des lésions persistantes et irréversibles des capillaires pulmonaires et pourrait servir à évaluer les fumeurs de chicha au long cours.Au total, l’utilisation occasionnelle de chicha chez le sujet jeune a des conséquence clinique et biologique pulmonaire en relation avec une diminution de la capacité de diffusion. Certaines anomalies mises en évidence dans notre étude (diminution de la capacité de diffusion, Microparticules endothéliales) pourraient prédire la survenue de maladies pulmonaires chroniques obstructives. / Waterpipe, an instrument for smoking fruit-flavored tobacco, is used by millions of people worldwide. There is limited data on the health effects of waterpipe smoking, and no regulations to its use. We hypothesized that even young, light-use waterpipe smokers have abnormalities relevant to lung health. Based on the knowledge that the first abnormalities associated with cigarette smoking are in lung cells long before there are clinical abnormalities, we compared young, light-use waterpipe smokers to nonsmokers, using a variety of lung-related parameters, including: blood carboxyhemoglobin (CO) levels; cough and sputum scores; lung function; metabolites present in lower respiratory tract epithelial lining fluid (ELF); cell differentials and transcriptome of small airway epithelium (SAE); cellular composition of ELF; transcriptome of alveolar macrophages (AM); and levels of total and apoptotic endothelial microparticles (EMPs). Light-use waterpipe smokers displayed abnormalities in all parameters assessed. Compared to nonsmokers, waterpipe smokers had more cough and sputum, higher CO levels, reduced diffusing capacity for carbon monoxide (DLCO), abnormal ELF metabolome profile, increased proportions of SAE secretory and intermediate cells, reduced proportions of SAE ciliated and basal cells, markedly abnormal SAE and AM transcriptomes, and elevated levels of total and apoptotic EMPs.DLCO, a lung function parameter linked to emphysema and small airway disease, was affected by light-use waterpipe smoking. The relevance of this comes from our studies that demonstrated, in a separate cohort of cigarette smokers with normal spirometry, that reduced DLCO predicted a high risk for developing chronic obstructive pulmonary disease (COPD), a leading cause of death worldwide. We assessed the risk for developing COPD, a clinical disorder characterized by a mixture of small airway disease and parenchymal destruction (emphysema), with a serial lung function in cigarette smokers with normal spirometry and no emphysema as assessed by HRCT, by comparing smokers with reduced DLCO vs normal DLCO. Despite having normal spirometry, cigarette smokers with reduced DLCO were at significantly higher risk for developing COPD within <4 years compared to those with normal DLCO i.e., the DLCO can be used to identify smokers at high risk for developing COPD, and could be a unique parameter in future studies to assess waterpipe smokers over time.Plasma levels of total and apoptotic EMPs, indicative of pulmonary capillary endothelial apoptosis, were elevated in light-use waterpipe smokers. The possible importance of this observation was highlighted by a parallel study, where we assessed the stability and reversibility of EMP levels in nonsmokers, healthy cigarette smokers and COPD cigarette smokers at 4 time points over a period of 1 year. The levels of total and apoptotic EMPs remained high with continuous smoking in healthy and COPD cigarette smokers. A subset of the healthy cigarette smokers and COPD cigarette smokers agreed to quit smoking. Following smoking cessation for 1 year, total and apoptotic EMP levels returned to normal nonsmoker levels in healthy cigarette smokers but remained abnormally high in COPD cigarette smokers. High levels of circulating and apoptotic EMPs are indicative of persistent and irreversible destruction of pulmonary capillaries and may be another unique parameter to assess waterpipe smokers over time.In summary, young, light-use waterpipe smokers have a number of lung clinical and biologic abnormalities compared to nonsmokers, including reduced DLCO, found to predict high risk for developing COPD in cigarette smokers, and elevated plasma levels of total and apoptotic EMPs, a marker of alveolar destruction, shown to be persistent and irreversible in COPD cigarette smokers despite smoking cessation. Together, these studies suggest that even light-use waterpipe smokers may be at risk for developing lung disease.

In this report, we analyze trends in interleukin-6 (IL-6) production in people living with human immunodeficiency virus (PLWH), as a function of smoking behaviors and race, using a clinic-based case-control design. Peripheral blood mononuclear cells (PBMCs) were collected from a multiethnic cohort of 120 PLWH to measure IL-6 in culture supernatant. The data indicated that stimulated PBMC produced significantly higher levels of IL-6 in smokers than nonsmokers. However, as expected, this relationship was substantially modified by race. The distinctive production of IL-6 across different racial groups highlights the need for additional studies and suggests that African American smokers have enhanced production of IL-6 than other groups. Additional analyses indicate that higher IL-6 levels are related to the predicted use of mentholated cigarettes, which are more frequently used by African Americans. These findings warrant further investigation and indicate the critical need for tailored preventive interventions.

Objective: To examine the relationship between pre-pregnancy weight and body image concerns and smoking status in late pregnancy. Methods: Participants included 172 pregnant smokers. Pre-pregnancy weight and body image concerns were assessed during first trimester via the Weight Concern Scale and Body Image Concern Inventory. Smoking status was evaluated at third trimester via self-report. Results: Logistic regression analyses revealed that weight concerns played a significant role in smoking continuation in late pregnancy. Conclusions: Beliefs about weight control properties of cigarettes may play an important role in smoking continuation among pregnant women. These findings suggest assessing weight concerns with pregnant women who smoke in an effort to facilitate successful cessation.

Objective: To examine the relationship between pre-pregnancy weight and body image concerns and smoking status in late pregnancy. Methods: Participants included 172 pregnant smokers. Pre-pregnancy weight and body image concerns were assessed during first trimester via the Weight Concern Scale and Body Image Concern Inventory. Smoking status was evaluated at third trimester via self-report. Results: Logistic regression analyses revealed that weight concerns played a significant role in smoking continuation in late pregnancy. Conclusions: Beliefs about weight control properties of cigarettes may play an important role in smoking continuation among pregnant women. These findings suggest assessing weight concerns with pregnant women who smoke in an effort to facilitate successful cessation.