Gary A. Giovino’s research while affiliated with University at Buffalo, State University of New York and other places

Background Although many studies suggested the benefit of smoking cessation among pregnant women in reducing the risk of preterm birth (PTB), the timing of the effect of the cessation remains inconclusive. Objectives To examine the association of trimester‐specific smoking cessation behaviours with PTB risk. Methods We included 199,453 live births in Western New York between 2004 and 2018. Based on self‐reported cigarette smoking during preconception and in each trimester, we created six mutually exclusive groups: non‐smokers, quitters in each trimester, those who smoked throughout pregnancy, and inconsistent smokers. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using Poisson regression to examine the association between smoking cessation and PTB. Effect modification by illegal drug use, maternal age, race and ethnicity and pre‐pregnancy body mass index (BMI) was investigated multiplicatively by ratio of relative risk and additively by relative excess risk due to interaction (RERI). Results Overall, 6.7% of women had a PTB; 14.1% smoked throughout pregnancy and 3.4%, 1.8% and 0.8% reported quitting smoking during the first, second and third trimesters, respectively. Compared to non‐smokers, third‐trimester cessation (RR 1.20, 95% CI 1.01, 1.43) and smoking throughout pregnancy (RR 1.27, 95% CI 1.21, 1.33) were associated with a higher PTB risk, while quitting smoking during the first or second trimester, or inconsistent smoking was not associated with PTB. A positive additive interaction was identified for maternal age and late smoking cessation or smoking throughout pregnancy on PTB risk (RERI 0.17, 95% CI 0.00, 0.36), and a negative interaction was observed for pre‐pregnancy BMI ≥30 kg/m ² (ratio of relative risk 0.70, 95% CI 0.63, 0.78; RERI −0.42, 95% CI −0.56, −0.30). Conclusion Compared to non‐smokers, smoking throughout pregnancy and third‐trimester smoking cessation are associated with an increased risk of PTB, while quitting before the third trimester may not increase PTB risk.

Background Prospective evidence on associations between diet quality indices and lung cancer risk is limited, particularly among older women. Objectives We investigated associations between 4 diet quality indices [Healthy Eating Index-2015 (HEI-2015), Alternate Healthy Eating Index 2010 (AHEI-2010), alternate Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH)] and lung cancer incidence and mortality in the Women's Health Initiative Observational Study. Methods Postmenopausal women aged 50–79 y at baseline (1993–1998) self reported their diet intake and information on relevant covariates. We used Cox proportional hazards regression models to estimate HRs and 95% CIs after controlling for age, smoking, and other relevant covariates. Results During ∼17 y of follow-up among 86,090 participants, 1491 lung cancer cases and 1393 lung cancer deaths were documented. Dietary indices were not associated with overall lung cancer incidence but were protective against squamous cell carcinoma (12.8% of total lung cancer) cases (HEI-2015: HR: 0.85; 95% CI: 0.76, 0.96; AHEI-2010: HR: 0.87; 95% CI: 0.78, 0.98; aMED: HR: 0.90; 95% CI: 0.81, 0.99; DASH: HR: 0.87; 95% CI: 0.77, 0.98). Among the indices, only HEI-2015 showed an inverse trend (P-trend = 0.02) with overall lung cancer mortality. Smoking status or participant age at baseline did not modify the association between dietary indices and lung cancer incidence or mortality. Conclusions After comprehensive control of smoking exposure, we found that diet quality was not associated with overall lung cancer among postmenopausal women. However, a high-quality diet was inversely related to incident lung cancer of the squamous cell subtype. Future studies in populations with diverse age, smoking history, and dietary intake may further elucidate the relation between diet quality indices and lung cancer, especially by histological subtype.

A working group (WG) of experts from diverse fields related to nicotine and tobacco addiction was constituted to identify constructs and measures for the PhenX (Phenotypes and eXposures) Tobacco Regulatory Research (TRR) Host: Biobehavioral Collection with potential relevance to users of both conventional and newer tobacco products. This paper describes the methods and results the WG used to identify, select, approve and place measures in the PhenX TRR Collection. The WG recognised 13 constructs of importance to guide their categorisation of measures already in the PhenX Toolkit ('complementary measures') and to identify novel or improved measures of special relevance to tobacco regulatory science. In addition to the 22 complementary measures of relevance to tobacco use already in the PhenX Toolkit, the WG identified and recommended nine additional Host: Biobehavioral measures characterising the use, exposure and health outcomes of tobacco products for application to TRR. Of these, five were self-administered or interviewer-administered measures: amount, type and frequency of recent tobacco use; flavor preference in e-cigarette users (adult and youth); pregnancy status and tobacco use; pregnancy status-mother and baby health and withdrawal from tobacco use. The remaining four measures were laboratory-based: cotinine in serum, expired carbon monoxide, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol in urine and cue reactivity. Although a number of validated tools are now available in the Host: Biobehavioral Collection, several gaps were identified, including a need to develop and test the identified measures in adolescent samples and to develop or identify measures of nicotine dependence, tolerance and withdrawal associated with newer non-combusted tobacco products.

Introduction Tobacco smoking is often more prevalent among those with lower socio-economic status (SES) in high-income countries, which can be driven by the inequalities in initiation and cessation of smoking. Smoking is a leading contributor to socio-economic disparities in health. To date, the evidence for any socio-economic inequality in smoking cessation is lacking, especially in low- and middle-income countries (LMICs). This study examined the association between cessation behaviours and SES of smokers from eight LMICs. Methods Data among former and current adult smokers aged 18 and older came from contemporaneous Global Adult Tobacco Surveys (2008–2011) and the International Tobacco Control Surveys (2009–2013) conducted in eight LMICs (Bangladesh, Brazil, China, India, Mexico, Malaysia, Thailand and Uruguay). Adjusted odds ratios (AORs) of successful quitting in the past year by SES indicators (household income/wealth, education, employment status, and rural-urban residence) were estimated using multivariable logistic regression controlling for socio-demographics and average tobacco product prices. A random effects meta-analysis was used to combine the estimates of AORs pooled across countries and two concurrent surveys for each country. Results Estimated quit rates among smokers (both daily and occasional) varied widely across countries. Meta-analysis of pooled AORs across countries and data sources indicated that there was no clear evidence of an association between SES indicators and successful quitting. The only exception was employed smokers, who were less likely to quit than their non-employed counterparts, which included students, homemakers, retirees, and the unemployed (pooled AOR≈0.8, p<0.10). Conclusion Lack of clear evidence of the impact of lower SES on adult cessation behaviour in LMICs suggests that lower-SES smokers are not less successful in their attempts to quit than their higher-SES counterparts. Specifically, lack of employment, which is indicative of younger age and lower nicotine dependence for students, or lower personal disposable income and lower affordability for the unemployed and the retirees, may be associated with quitting. Raising taxes and prices of tobacco products that lowers affordability of tobacco products might be a key strategy for inducing cessation behaviour among current smokers and reducing overall tobacco consumption. Because low-SES smokers are more sensitive to price increases, tobacco taxation policy can induce disproportionately larger decreases in tobacco consumption among them and help reduce socio-economic disparities in smoking and consequent health outcomes.

Background: Prospective evidence on the association between diet patterns and lung cancer risk is limited, particularly in older women. We investigated whether commonly used diet quality indices - Healthy Eating Index 2010 (HEI), Alternate Healthy Eating Index 2010 (AHEI), alternate Mediterranean Diet (aMED) and Dietary Approaches to Stop Hypertension (DASH) - were associated with lung cancer incidence and mortality in the Women's Health Initiative Observational Study (WHI OS). Methods: Self-reported diet intake (food frequency questionnaires) and relevant covariate information was obtained from 86,090 race-ethnically diverse postmenopausal women aged 50-79 years at baseline (1993-1998). During a median follow-up of approximately 17 years, 1,491 lung cancer cases and 1,393 lung cancer deaths were documented. We used cox proportional hazards regression models to estimate hazards risks and 95% confidence intervals [HR (95% CI)] after controlling for age, race/ethnicity, education, body mass index, smoking, physical activity and energy intake. Results and conclusions: Diet quality indices were not associated with lung cancer incidence overall but all four dietary indices showed a protective association (highest versus lowest quintile) against squamous cell carcinoma cases (12.8% of total lung cancer cases) [HEI: 0.56 (0.33-0.96), AHEI: 0.42 (0.24-0.76), aMED: 0.65 (0.39-1.08), DASH: 0.56 (0.32-0.97)]. Diet quality indices were not associated with lung cancer mortality overall or when stratified by histological type, except for HEI with lung cancer mortality overall [fourth versus lowest quintile: 0.82 (0.69-0.99)]. Smoking status did not modify the association between diet quality indices and lung cancer incidence or mortality. Further studies in other populations may help elucidate the relationship between diet patterns and lung cancer, especially by histological type. Citation Format: Ajay A. Myneni, Gary A. Giovino, Amy E. Millen, Michael J. LaMonte, Jean Wactawski-Wende, Marian L. Neuhouser, Jiwei Zhao, James M. Shikany, Lina Mu. Indices of diet quality and risk of lung cancer incidence and mortality in the Women's Health Initiative Observational Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5261.

Aims This review provides an up‐to‐date curated source of information on alcohol, tobacco, and illicit drug use and their associated mortality and burden of disease. Limitations in the data are also discussed, including how these can be addressed in the future. Methods Online data sources were identified through expert review. Data were mainly obtained from the World Health Organization, United Nations Office on Drugs and Crime, and Institute for Health Metrics and Evaluation. Results In 2015, the estimated prevalence among the adult population was 18.3% for heavy episodic alcohol use (in the past 30 days); 15.2% for daily tobacco smoking; and 3.8%, 0.77%, 0.37%, and 0.35% for past‐year cannabis, amphetamine, opioid, and cocaine use, respectively. European regions had the highest prevalence of heavy episodic alcohol use and daily tobacco use. The age‐standardised prevalence of alcohol dependence was 843.2 per 100,000 people; for cannabis, opioids, amphetamines and cocaine dependence it was 259.3, 220.4, 86.0 and 52.5 per 100,000 people, respectively. High‐Income North America region had among the highest rates of cannabis, opioid, and cocaine dependence. Attributable disability‐adjusted life‐years (DALYs) were highest for tobacco (170.9 million DALYs), followed by alcohol (85.0 million) and illicit drugs (27.8 million). Substance‐attributable mortality rates were highest for tobacco (110.7 deaths per 100,000 people), followed by alcohol and illicit drugs (33.0, and 6.9 deaths per 100,000 people, respectively). Attributable age‐standardised mortality rates and DALYs for alcohol and illicit drugs were highest in Eastern Europe; attributable age‐standardised tobacco mortality rates and DALYs were highest in Oceania. Conclusions In 2015 alcohol and tobacco use between them cost the human population more than a quarter of a billion disability‐adjusted life years, with illicit drugs costing a further tens of millions. Europeans proportionately suffered more but in absolute terms the mortality rate was greatest in low and middle income countries with large populations and where the quality of data was more limited. Better standardised and rigorous methods for data collection, collation and reporting are needed to assess more accurately the geographical and temporal trends in substance use and its disease burden.

Context: Cancer patients' continued tobacco use results in poorer therapeutic outcomes including decreased quality of life and survival. Objective: To assess reach and impact of a free, opt-out, telephone-based tobacco cessation program for thoracic cancer center patients. Design: Observational study. Setting: Comprehensive Cancer Center in Western New York. Participants: Current or recent (within past 30 days) tobacco-using thoracic cancer center patients referred to a tobacco cessation support service between October 2010 and October 2012 at a Comprehensive Cancer Center (n = 942/1313 referrals were eligible for cessation support). Intervention: A free, opt-out, telephone-based cessation service that was implemented as standard of care. Cessation specialists had patient-guided conversations that assessed readiness to quit; methods used in the past provided cessation strategies and worked to set up a quit date. There was an average of 35.9 days between referral and first contact. Main outcome measures: Program reach (referral and participation rates) and impact (as self-reported cessation outcomes measured twice after referral). Results: Of 942 patients, 730 (77.5%) referred to and called by a tobacco cessation service participated in at least 1 cessation support call, of which 440 of 730 (60.3%) were called for follow-up and 89.5% (394/440) participated. In total, 20.2% (69/342) of current smokers at referral reported at least 7-day abstinence at follow-up. Among current smokers at referral and first contact, being married (odds ratio [OR] = 2.05; 95% confidence interval [CI], 1.01-4.18) and having a lower Eastern Cooperative Oncology Group (ECOG) performance score (OR = 4.05; 95% CI, 1.58-10.39) were associated with quitting at follow-up, after controlling for demographic, clinical, and health behavior characteristics. Conclusions: Our results demonstrate that 78% of thoracic cancer center patients, if contacted, participated at least once in this cessation support service; for current smokers at referral and first contact, being married and having a lower ECOG performance score were associated with self-reported quitting at follow-up. Other organizations may find our results useful while implementing a systematic way to identify tobacco-using patients as part of routine care and to improve available cessation support services.

Background: The WHO Framework Convention on Tobacco Control (WHO FCTC) has mobilised efforts among 180 parties to combat the global tobacco epidemic. This study examined the association between highest-level implementation of key tobacco control demand-reduction measures of the WHO FCTC and smoking prevalence over the treaty's first decade. Methods: We used WHO data from 126 countries to examine the association between the number of highest-level implementations of key demand-reduction measures (WHO FCTC articles 6, 8, 11, 13, and 14) between 2007 and 2014 and smoking prevalence estimates between 2005 and 2015. McNemar tests were done to test differences in the proportion of countries that had implemented each of the measures at the highest level between 2007 and 2014. Four linear regression models were computed to examine the association between the predictor variable (the change between 2007 and 2014 in the number of key measures implemented at the highest level), and the outcome variable (the percentage point change in tobacco smoking prevalence between 2005 and 2015). Findings: Between 2007 and 2014, there was a significant global increase in highest-level implementation of all key demand-reduction measures. The mean smoking prevalence for all 126 countries was 24·73% (SD 10·32) in 2005 and 22·18% (SD 8·87) in 2015, an average decrease in prevalence of 2·55 percentage points (SD 5·08; relative reduction 10·31%). Unadjusted linear regression showed that increases in highest-level implementations of key measures between 2007 and 2014 were significantly associated with a decrease in smoking prevalence between 2005 and 2015). Each additional measure implemented at the highest level was associated with an average decrease in smoking prevalence of 1·57 percentage points (95% CI −2·51 to −0·63, p=0·001) and an average relative decrease of 7·09% (−12·55 to −1·63, p=0·011). Controlling for geographical subregion, income level, and WHO FCTC party status, the per-measure decrease in prevalence was 0·94 percentage points (−1·76 to −0·13, p=0·023) and an average relative decrease of 3·18% (−6·75 to 0·38, p=0·079). This association was consistent across all three control variables. Interpretation: Implementation of key WHO FCTC demand-reduction measures is significantly associated with lower smoking prevalence, with anticipated future reductions in tobacco-related morbidity and mortality. These findings validate the call for strong implementation of the WHO FCTC in the WHO's Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013–2020, and in advancing the UN's Sustainable Development Goal 3, setting a global target of reducing tobacco use and premature mortality from non-communicable diseases by a third by 2030. Funding: Health Canada, Canadian Institutes of Health Research, Ontario Institute for Cancer Research and Canadian Cancer Society Research Institute.

Introduction: The inter-relationships between smoking habits and weight gain are complex. However, few studies have examined the association of smoking habits with weight gain over the life course. Methods: Major smoking parameters and weight gain over time were examined in a large cohort of postmenopausal women aged 50-79 years at enrollment between 1993 and 1998 (N=161,808) and followed through 2014 (analyses conducted in 2016). Cross-sectional analyses were used to assess the association of smoking and body weight at baseline. Retrospective data were used to correlate smoking status with body weight over a 45-year period prior to enrollment. In addition, the association of smoking with weight gain over 6 years of follow-up was examined. Results: At baseline, women who had quit smoking prior to enrollment weighed 4.7 kg more than current smokers and 2.6 kg more than never smokers. Former, never, and current smokers all gained weight over the 45-year period from age 18 years to time of enrollment (average age, 63 years): 16.8, 16.4, and 14.6 kg, respectively. In prospective analyses, women who were current smokers at baseline but who quit smoking during follow-up gained more than 5 kg by Year 6 compared with current smokers at baseline who continued to smoke. Among long-term quitters, greater intensity of smoking and more recent quitting were associated with greater weight gain. Conclusions: These results suggest that excess weight gain associated with smoking cessation occurs soon after quitting and is modest relative to weight gain in never smokers over the adult lifespan.