Faculty Bibliography

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.

OBJECTIVE: To examine whether household food insecurity is associated with serious psychological distress (SPD) in fathers and mothers in a nationally representative US sample. METHODS: We analyzed cross-sectional, matched child-parent data from the 2014 to 2015 National Health Interview Survey (N = 18,456). Parental psychological distress was assessed using the Kessler-6 (K-6) scale. Family food security was measured using the USDA's 10-item Food Security scale, and households were dichotomized as food secure or food insecure. Multivariate logistic regression analyses were performed to examine associations between SPD and food insecurity stratified by parental status (mother/father), controlling for sociodemographic factors. RESULTS: One hundred forty-seven (2.0%) fathers, 444 (3.9%) mothers, and 591 (3.2%) of all parents had K-6 scores indicating SPD. A total of 2414 (13.1%) parents reported being food insecure, including 750 (10.4%) fathers and 1664 (14.8%) mothers. In multivariate analyses, food insecurity was significantly associated with SPD both among fathers and mothers (odds ratio [OR] = 4.2; 95% confidence interval [CI], 2.4-7.3 and OR = 2.6; 95% CI, 1.9-3.5, respectively). CONCLUSION: This is the first study we are aware of to demonstrate that food insecurity is independently associated with SPD among fathers and mothers, and that fathers may be at higher risk of SPD than mothers in food insecure homes. These findings highlight the need to assess and treat the mental health of fathers, a historically underrepresented group in the fields of mental health and pediatrics, in addition to mothers, in food insecure homes.

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 (P < 0.05). 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.

Environmental tobacco smoke (ETS) is one of the greatest and the most frequent environmental toxic exposures presenting a high risk to children and to their mothers as well. The aim of the study was to find determinants of the household ETS in the sample of pregnant women living in the household with smokers and to assess their physical and mental health. The survey was distributed to women being seen for follow-up at the obstetric/gynecology departments in hospitals and at gynecological out-patient departments in Bratislava, Slovakia. The medical outcomes short form-12 (SF-12) was included to quantify the mental and physical health of mothers. From the total sample of 617 women, 35.5% (219) were pregnant, 88.6% of them (194) non-smokers, 27.8% (54) lived with a smoking partner, the average mental component summary (MCS) score was 50.8±9.1 and physical component summary (PCS) score was 41.6±10.3. The average age was 31.3±5.1 years. In the sample of 309 non-pregnant non-smoking mothers 23% (71) lived with a smoking partner; the average age was 31.7±4.8 years. The average PCS score was 47.8±8.7 and MCS score 49.1±9. Non-smoking, pregnant women living with a smoker have fewer years of education (p=0.0003) and lower MCS scores (48.50±9.8) (p=0.03). Non-smoking, non-pregnant women living with a smoker are older (p=0.0042), with lower income (p=0.0145), have fewer years of education (p=0.002) and lower PCS score (45±9.1) (p=0.0056). Multivariate analyses revealed the decrease of MCS score in pregnant women and the decrease of PCS score in non-pregnant women living with a smoker. Our results show that living with a smoker is independently associated with worse physical and mental health in a selected sample of Slovak women, which represents an important argument for intervention in families.

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 (PM2.5), fine black carbon (BC2.5), 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 gamma (IFN-gamma), tumour necrosis factor (TNF-alpha)) were assessed in workers immediately prior to and immediately after their work shift. RESULTS: The PM2.5 (gravimetric) and BC2.5 concentrations in indoor air varied greatly among the work shifts with mean levels of 363.8 microg/m3 and 2.2 microg/m3, 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-Upsilon increasing from 0.85 (0.13) to 1.6 (0.25) (mean (standard error of the mean; SEM)) pg/mL (p<0.01). Exhaled CO levels were significantly elevated after the work shift with 2 of 10 workers having values >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.

BACKGROUND: Psychological distress has been correlated with higher levels of nicotine dependence. To date, the possible association between individuals' levels of psychological distress and e-cigarette use has not been investigated, despite the dramatic growth of e-cigarette use in the US. We examined this possible association using a nationally representative sample of US adults. METHODS: A total of 36,697 adults from the 2014 National Health Interview Survey (NHIS) were included. The Kessler 6 scale was used to measure psychological distress. Multivariate logistic regression analysis was conducted to assess the association between level of psychological distress and e-cigarette use. RESULTS: Both e-cigarette and cigarette use varied according to level of psychological distress as well as multiple socio-demographic characteristics. In a multivariate model, psychological distress was significantly associated with the following groups: (a) exclusive e-cigarette ever-use (aOR = 3.7; 95% CI = 1.6, 8.6), (b) current dual use of e-cigarettes and cigarettes (aOR = 4.6; 95% CI = 3.1, 6.7), (c) former cigarette use and ever use of e-cigarette (aOR = 3.2; 95% CI = 2.2, 4.8) and (d) current use of cigarettes only (aOR = 2.1; 95% CI = 1.7, 2.6). CONCLUSION: These are the first data to demonstrate that, as is true for cigarettes, e-cigarette use is associated with increased levels of psychological distress. Further large-scale, longitudinal studies are needed to determine the direction of this relationship and to evaluate the long-term positive and negative consequences of such use.

INTRODUCTION: There has been a sharp decline in adolescents who smoke cigarettes but no national-level study evaluating the impact of smoking cessation counseling by pediatricians or other clinicians who care for children. METHODS: Combined data from ambulatory portions of the National Hospital Ambulatory Care Survey and National Ambulatory Medical Care Survey from 1997-1999 and 2009-2011 were analyzed to determine changes in the frequency of pediatric visits that included clinician-reported tobacco counseling and how such counseling varied by child, family, and clinician characteristics. RESULTS: In 1997-1999, 1.5% of all medical visits for children aged below 19 years included tobacco counseling; this increased to 3.8% in 2009-2011 (P < .001). A marked increase from 4.1% to 11.1% was noted at well-child visits (P < .001). There were significant increases in counseling by pediatricians but not mid-level providers or general/family physicians. Provision of counseling did not result in greater visit length during either time point. During 2009-2011, visits with a diagnosis of asthma were four times as likely (OR 4.2, 95% CI 2.8-6.2) and visits for otitis media two times as likely (OR 2.1, 95% CI 1.2-3.7) to include smoking cessation counseling than sick visits for all other diagnoses. CONCLUSION: These results demonstrate a significant increase in tobacco counseling by pediatric providers within the last decade, especially at well-child visits. However, the American Academy of Pediatrics' recommendation that pediatricians counsel about the harms of tobacco use and secondhand smoke exposure has not yet been exhaustively implemented. IMPLICATIONS: A significant increase in smoking cessation counseling at pediatric medical appointments, especially at well-child visits, occurred from 2009-2011 compared with 1997-1999, paralleling a large decrease in smoking prevalence. These improvements in counseling rates have been predominantly noted for pediatricians but not mid-level providers or general practitioners. Counseling was not associated with increased visit lengths. Although improved counseling practices by pediatricians have been demonstrated, there is still room for improvement.