11th Annual Conference of the International Diseases (ISPTID)

Transcription

Tobacco Induced Diseases 2014, Volume 12 Suppl 1
http://www.tobaccoinduceddiseases.com/supplements/12/S1
MEETING ABSTRACTS
Open Access
11th Annual Conference of the International
Society for the Prevention of Tobacco Induced
Diseases (ISPTID)
Athens, Greece. 9-11 December 2013
Edited by Constantine Vardavas, Charis Girvalaki, Christina Gratziou and Panagiotis Behrakis
Published: 06 June 2014
These abstracts are available online at http://www.tobaccoinduceddiseases.com/supplements/12/S1
INTRODUCTION
A1
Education for a tobacco free world: the 11th meeting of the
International Society for the Prevention of Tobacco Induced Diseases
(ISPTID)
Constantine Vardavas1,2,3,4*, Charis Girvalaki4, Christina Gratsiou5,
Panagiotis Behrakis1,2,3,6
1
Center for Global Tobacco Control, Department of Social and Behavioral
Sciences, Harvard School of Public Health, Boston, USA; 2Smoking and Lung
Cancer Research Center, Hellenic Cancer Society, Athens, 11521, Greece;
3
Biomedical Research Foundation of the Academy of Athens, Athens, 115 27,
Greece; 4Department of Social Medicine, Clinic of Social and Family
Medicine, University of Crete, Heraklion, Greece; 51st Respiratory Department,
University of Athens, Medical School, Sotiria Hospital, Athens, 11527, Greece;
6
Department of Environmental Health, Harvard School of Public Health, 677
Huntington Avenue Landmark, West Boston, MA 02115, USA
Tobacco Induced Diseases 2014, 12(Suppl 1):A1
With tobacco the single most preventable cause of death and disability
on the planet and potentially responsible for more than a billion deaths
this century –if urgent action is not taken- the importance of tackling the
tobacco epidemic at its roots is clearly apparent [1].
Within the context of tackling this public health behemoth, the
11th meeting of the International Society for the Prevention of Tobacco
Induced Diseases (ISPTID) in Athens, Greece took place in tandem with the
4 th Panhellenic Congress on Tobacco Control in December 2013. The
conference brought together a multidisciplinary group of participants in
two separate, but inter-complimentary, tracks: one focused on the scientific
aspects of the prevention of tobacco attributable diseases, and one
focused on education and learning for a tobacco free world.
Track 1: the science behind preventing tobacco use: Over 250
participants from countries spanning the geography of the planet followed
62 oral/keynote presentations and 26 lively poster discussions within the
auditorium of the Biomedical Research Foundation of the Academy of
Athens (BRFAA). So as to limit participant dispersion between rooms,
parallel sessions were limited to a maximum of two at a time. Scientific
support was provided by the journal, Tobacco Induced Diseases –which
also hosts the current abstract book of selected presentations. Topics
covered multiple areas including: Modified risk products, e-cigarettes,
tobacco use and disease epidemiology, occupational health, clinical impact
of tobacco induced diseases, molecular/cellular impact of tobacco use,
smoking cessation, and finally educational and community interventions
for reducing tobacco use among youth. Within the context of the
conference the ED Nelson award was also presented to the best first
appearing young researcher in tobacco control.
Track 2: education for a tobacco free future: Adolescence is a crucial
period in human development, as during this phase the majority of
smokers experiment with their first cigarettes, a risky behaviour which
may continue into adulthood, that however can be prevented with
school or community based strategic actions that enhance and
facilitate the adoption of a tobacco free life [2]. School prevention
programs which start in upper elementary or middle school, and
continue into high school are necessary and able to provide important
results towards rejecting smoking initiation [3]. Within the context of
the joint 11th IISPTID meeting with the 4th Panhellenic Congress on
Tobacco Control a special parallel track and specific day was designed
so as to facilitate training of teachers and educators, and also peer to
peer training between school students. This track was followed by a
total of 1340 students, within the auditorium of the Ministry of
Education of Greece, and 1041 online school connections, 69 of which
followed the session via distance in real time. During the process
leading up to this conference, students submitted more than a
thousand drawings, works of art, and short videos as part of the
national campaign for a tobacco free future, the best of which were
awarded in the closing ceremony –which ended with a live POP
concert for a tobacco free future [4].
In conclusion, the conference’s main take home was clear and simple:
Education, whether peer to peer, or through the community or school
system is an integral part of preventing tobacco induced diseases.
Together a tobacco free future is possible and education can pave
the way.
Competing interests: The authors declare that they have no competing
interests.
Authors’ contributions: All authors contributed equally in preparation of
this manuscript. All authors read and approved the final manuscript.
Acknowledgements: The authors gratefully acknowledge the help of
numerous colleagues at the local and international levels for the
organization of this meeting in Athens, Greece. We would also like to
thank the schools, students and Greek national educational system for
warmly embracing this action. The conference was supported by the
ISPTID and the HEART II project, awarded to the BRFAA (P Behrakis).
References
1. Peto R, Lopez AD: The future worldwide health effects of current
smoking patterns. Critical issues in global health San Francisco: Jossey-Bass:
Koop E, Pearson CE, Schwarz MR 2001, 154-61.
2. Vardavas C, Preventing adolescent smoking: Key points in preventing
tobacco use among adolescents. Tobacco Induced Diseases 2010, 8:1.
© 2014 various authors, licensee BioMed Central Ltd. All articles published in this supplement are distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
3.
4.
Flay B: School-based smoking prevention programs with the promise of
long-term effects. Tobacco Induced Diseases 2009, 5:6.
Smokefree Greece; A country without tobacco. , Available at http://
smokefreegreece.gr/ (last accessed 26 May 2014) (in Greek).
MEETING ABSTRACTS
A2
Novel curriculum of smoking cessation for dental students
Takashi Hanioka
Dept. of Preventive and Public Health Dentistry, Fukuoka Dental College,
Fukuoka, 814-0193, Japan
Background: Dental professionals have not fully embraced opportunities
for tobacco intervention. The aim of my presentation is to suggest new
strategy of curriculum to enhance smoking cessation intervention based on
the novel findings that may useful under the universal health insurance
system in Japan.
Materials and methods: Reviewed literatures regarding tobacco
interventions by dental professionals and recent studies regarding oral
microbiology, and surveyed dentists and dental patients to clarify the
possibility of our strategy.
Results: The literature review regarding progression of the global dental
tobacco interventions identified significant barriers such as lack of
reimbursement and training for implementation to dental practice and
dissemination and undergraduate education. Recent findings regarding the
effects of smoking cessation on oral biofilms and those of tobacco extracts
on virulence factor of periodontal pathogens would break the ice to
enforce dental tobacco intervention in Japan. The studies that was
conducted in dental clinics revealed that tobacco intervention for
prevention of progression of dental disease and improvement of the
effects of dental treatments that have potential coverage of the universal
health insurance system in Japan were strongly supported by dentists
while intervention services for prevention of oral diseases was strongly
supported by dental patients.
Conclusions: Education for dental students regarding tobacco intervention
based on the effects on dental treatments would be promising strategy
that reinforces those for oral and overall health in Japan.
A3
Epidemiology of smoking among the employees of a medical university
and strategies to decrease prevalence
Karoly Viragh1, Eniko Viragh2*
1
Olive View UCLA Medical Center, Sylmar, Los Angeles, California, 91342,
USA; 2University of Medicine and Pharmacy, Targu Mures, 540139, Romania
E-mail: [email protected]
Background: The purpose of the study is to assess the prevalence of
smoking among the employees of a medical university, to provide
descriptive statistics of the actual situation, and to suggest university
targeted policy changes in reducing smoking for the ultimate goal of a
smoke-free campus.
Materials and methods: A review of the medical files of all employees
of the University of Medicine and Pharmacy, Targu Mures, Romania
(UMF-TGM), was performed in the Occupational Health and Safety Office in
July 2013. For each employee, the person’s age, gender, occupation, and
smoking history (pack-years, reasons to start, reasons to quit) were recorded.
Epidemiological data analysis was performed using Microsoft Excel and
the data was organized in subgroups based on age, gender and occupation.
The significance levels were assessed. The study was performed in
concordance with university research policy.
Results: UMF-TGM has 677 total employees, of which 6 had no information
available. Of the 671 employees with information, the age range was
26-65 years with a median of 44 years. There were 218 smokers (32.0%,
1-to-56 pack-year range) and 453 non-smokers (68.0%), of which 406 never
smoked and 47 were former smokers. There were 390 women (113 smokers,
29.0%) and 281 men (105 smokers, 37.0%). There were 375 health
professionals, of which 295 were physicians (72 smokers, 24.0%), 51 were
Page 2 of 14
dentists (16 smokers, 31.0%), and 29 pharmacologists (6 smokers, 21.0%).
The teaching faculty had 413 members (health professionals and non-health
professionals), of which 108 were smokers (26.0%). The non-teaching
university employees (technicians, administrative assistants, maintenance
personnel) included 258 persons, of which 110 (43.0%) were smokers.
Reasons to start smoking included the presence of smokers in the social
environment, curiosity/boredom, and coolness. Reasons to quit smoking
included health, money and social environment.
Conclusions: Despite of major public health efforts, smoking remains one
of the most important causes of morbidity and mortality. The prevalence
rate of smoking at UMF-TGM is 32.0%, which was significantly higher in
men and non-teaching employees than in women and teaching faculty.
These rates are unacceptably high, given that a medical institution should
set example of a smoke-free environment and healthy lifestyle. Current
university smoking policy conforms to the national smoking policies;
however, there are no targeted programs in place to reduce smoking.
Therefore, initiatives will be presented to the university to increase
awareness and assist current smokers in quitting.
A4
Smoking habits, attitudes and training among medical students of the
Democritus University of Thrace
Georgios-Marios Pantsidis1*, Dimitra-Iosifina Papageorgiou2,
Demosthenes Bouros1
1
Faculty of Medicine, Democritus University of Thrace, Alexandroupolis,
68100, Greece; 2Faculty of Medicine, University of Thessaly, Larisa, 41110,
Greece
Background: Tobacco use continues to be the leading global cause of
preventable death, contributing to the death of nearly 6 million people
each year. Medical students, who are future doctors, have an important
role to play in smoking cessation and prevention. The objective of this
study was to estimate the prevalence of tobacco use among medical
students of Democritus University of Thrace Medical School, and to
evaluate their smoking-related attitudes and their training in tobacco
issues they receive during their studies in University.
Materials and methods: This study was conducted from March to May
2011. The students were asked to complete a modified version of the
Global Professional Students’ Survey (GHPSS) questionnaire. The final study
population consisted of 233 randomly selected students in the 1st-6th year
of medical studies.
Results: Of the 233 students invited to participate, 229 submitted
adequately completed questionnaires. Of this sample, 24% were smokers,
38.2% of whom had experimented with smoking at the age of 11-15 years.
The banning of smoking in all enclosed public places was considered
useful by 88.6% with a statistically significant difference between smokers
and non-smokers (65.5% vs. 96%, p<0.001). Of the participants, 31%
believed that slim/light and hand-rolled cigarettes are less harmful and
only 8.1% had been taught cessation techniques and 17.8% the reasons
why people smoke.
Conclusions: The study shows that the prevalence of smoking among
medical students in northern Greece is high compared with other
countries. It is evident that the issue of tobacco use is not covered
adequately and systematically by the Medical School curriculum.
A5
Comparing smoking habits and tobacco-related education between
Canadian and Greek medical students
Georgios-Marios Pantsidis1*, Dimitra-Iosifina Papageorgiou2,
Demosthenes Bouros1
1
Faculty of Medicine, Democritus University of Thrace, Alexandroupolis,
68100, Greece; 2Faculty of Medicine, University of Thessaly, Larisa, 41110,
Greece
Background: According to a survey on Canadian medical students’
smoking habits and beliefs, the key results show that the prevalence of
smoking among the future healthcare professionals is high and they lack
of tobacco-related education [1]. Last year a similar survey was conducted
at Democritus University of Thrace [2]. Its findings show that there is
difference in smoking habits between the two students’ groups, but their
tobacco-related education is equally poor.
Materials and methods: In both researches participated undergraduate
students who completed a questionnaire about their smoking habits,
attitudes and education level towards tobacco cessation interventions.
Results: The prevalence of cigarette smoking among Greek medical
students is higher than the Canadians (24% vs. 3.3%). Although Canadian
students smoke, also, other tobacco products (cigars, water pipe), the
total prevalence is 15.3%. 65.5% of the Greek medical students report
that they had ever tried cigarettes, but only 29.9% of the Canadian
students make a same statement. Both students groups reported that
they have moderate levels of education concerning tobacco-related
subjects and cessation techniques. Only 8.1% of Greek and 10% of
Canadian medical students report that they had ever received trainings in
smoking cessation methods. Finally only a small percentage seems to be
familiar with the cessation guidelines and only a few students are aware
of the fact that they lack knowledge to help their patients cease smoking.
Conclusions: The prevalence of cigarettes smoking among Greek medical
students is significantly higher. Also the tobacco-related education in
both countries is equally poor. It is desperately necessary to enhance the
medical schools’ curricula with courses regarding smoking issues, since
future physicians have a key-role in tobacco cessation and prevention.
References
1. Vanderhoek AJ, Hammal F, Chappell A, Wild TC, Raupach T, Finegan BA:
Future physicians and tobacco: An online survey of the habits, beliefs
and knowledge base of medical students at a Canadian university.
Tobacco Induced Diseases 2013, 11(1):9.
2. Pantsidis GM, Papageorgiou DI, Bouros D: Smoking habits, attitudes and
training among medical students of the Democritus University οf
Thrace. Pneumon 2012, 25:208-218.
A6
Screening for urinary bladder cancer with the use of nuclear matrix
protein (NMP) 22: is it feasible?
Anastasios Stefanopoulos1,2*, Konstantinos P Economopoulos2,3
1
Medical school, National and Kapodistrian University of Athens, Athens, 115
27, Greece; 2Society of Junior Doctors, Athens,15123, Greece; 3Massachusetts
General Hospital, Harvard Medical School, Boston, Massachusetts, 02114, USA
Background: Tobacco use accounts for the majority of urinary bladder
cancer (UBC) cases both in men and women. It is widely accepted that
smokers have increased risk of UBC [1-4]. An early diagnosis of UBC is
crucial because patients with superficial UBC have much better prognosis
than those with invasive UBC [1,2,4,5]. During the past years a variety of
urine based markers have been introduced for screening of UBC. Nuclear
matrix protein 22 (NMP22) is a nuclear protein that is accountable for
chromatid regulation and cell separation during replication. The detection
of NMP22 has been used from many clinical studies to evaluate the
possibility of UBC screening [2,6-8]. The purpose of this review is to
access the current literature in order to determine the usefulness of
NMP22 in screening of UBC.
Materials and methods: A thorough search was conducted in MEDLINE
using the terms urinary bladder cancer OR urinary bladder neoplasm,
NMP22 and screening. The following inclusion criteria were adopted:
i. studies that NMP22 was measured in high risk patients without UBC
and ii. studies that NMP22 was compared between patients with
known history of UBC and a control group without history of UBC.
We excluded studies that NMP22 was used only for the surveillance
of UBC.
Results: 185 English-language articles were retrieved and 38 were included
in this study. Average total sensitivity of NMP22 was 73.44 ± 15.11% and
average total specificity 72.82 ± 16.27%. Positive predictive value (PPV) was
37.12 ± 26.11% and negative predictive value (NPV) was 87.47 ± 10.60%.
Two studies did not report total specificity or sensitivity rates. The majority
of the reports concluded than NMP22 cannot be used for screening
nosn-invasive UBC but benefits the screening for high grade UBC in
Page 3 of 14
symptomatic patients. However there is no study in the literature that
indicates that NMP22 detection approaches level 1 of evidence in
screening for UBC. Based on the fact that the prevalence of UBC in
asymptomatic high risk patients without history of UBC is low (4.0%), the
diagnostic value of mass screening programs in asymptomatic patients is
questionable.
Conclusions: Detection of NMP22 is a non-invasive test that can be
easily applied and gives diagnostic answers very quickly especially for
tobacco-induced high grade tumors. NMP22 detection cannot replace
cystoscopy. It is essential, more studies to be conducted with careful
selection of patients, in order to find out, if NMP22 or a combination with
other markers are useful for diagnosing UBC [1,2,5].
References
1. Roobol MJ, Bangma CH, el Bouazzaoui S, Franken-Raab CG, Zwarthoff EC:
Feasibility study of screening for bladder cancer with urinary molecular
markers (the BLU-P project). UrolOncol 2010, 28(6):686-90.
2. Grossman H, Messing E, Soloway M, Tomera K, Katz G, Berger Y, Shen Y:
Detection of Bladder Cancer Using a Point-of-Care Proteomic Assay.
JAMA 2005, 293(7):810-816.
3. Huber S, Schwentner C, Taeger D, Pesch B, Nasterlack M, Leng G,
Mayer T, Gawrych K, Bonberg N, Pelster M, Johnen G, Bontrup H,
Wellhäusser H, Bierfreund HG, Wiens C, Bayer C, Eberle F, Scheuermann B,
Kluckert M, Feil G, Brüning T, Stenzl A, UroScreen Study Group: Nuclear
matrix protein-22: a prospective evaluation in a population at risk for
bladder cancer. Results from the UroScreenstudy. BJU Int 2012,
110(5):699-708.
4. Lotan Y, Capitanio U, Shariat SF, Hutterer GC, Karakiewicz PI: Impact of
clinical factors, including a point-of-care nuclear matrix protein-22
assay and cytology, on bladder cancer detection. BJU Int 2009,
103(10):1368-74.
5. Lotan Y, Elias K, Svatek RS, Bagrodia A, Nuss G, Moran B, Sagalowsky AI:
Bladder cancer screening in a high risk asymptomatic population using
a point of care urine based protein tumor marker. J Urol 2009,
182(1):52-7.
6. Ramakumar S, Bhuiyan J, Besse JA, Roberts SG, Wollan PC, Blute ML,
O’Kane DJ: Comparison of screening methods in the detection of
bladder cancer. J Urol 1999, 161(2):388-94.
7. Moonen PM, Kiemeney LA, Witjes JA: Urinary NMP22 BladderChek test in
the diagnosis of superficial bladder cancer. EurUrol 2005, 48(6):951-6.
8. Shariat SF, Marberger MJ, Lotan Y, Sanchez-Carbayo M, Zippe C, Lüdecke G,
Boman H, Sawczuk I, Friedrich MG, Casella R, Mian C, Eissa S, Akaza H,
Serretta V, Huland H, Hedelin H, Raina R, Miyanaga N, Sagalowsky AI,
Roehrborn CG, Karakiewicz PI: Variability in the performance of nuclear
matrix protein 22 for the detection of bladder cancer. J Urol 2006,
176(3):919-26.
A7
Effects of a natural polyphenol on nicotine -induced pancreatic cancer
cell proliferation
Parimal Chowdhury*, John JayRoe
Department of Cellular Physiology and Molecular Biophysics, University of
Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
Background: Resveratrol (3, 5, 4’-trihydroxy-transstilbene), a phytoalexin
derived from the skin of grapes and other fruits is perhaps cancer
chemo-preventive. It is known to have potent anti-inflammatory and antioxidant effects and inhibit platelet aggregation and the growth of a
variety of cancer cells. In vitro and in vivo studies have confirmed that
resveratrol can modulate multiple pathways involved in cell growth,
apoptosis, and inflammation. Its anti-carcinogenic effects appear to be
closely associated with its antioxidant activity, and thus the use of
resveratrol in human cancer chemoprevention, provide a rationale in
support of its use. However it is not known, whether or not it provides
the inhibitory effects on proliferative pancreatic cancer cells induced
by nicotine.
Materials and methods: In this study we have examined the effects of
resveratrol on nicotine induced pancreatic cancer cell proliferation. Two
different cultured pancreatic cancer cell lines were used in this study. Cell
proliferation was examined in a dose and time dependent manner by
MTT assay and its mechanism was further examined through mitogen
activated protein kinase signal transduction pathways (MAPK) employing
ERK 1 and ERK 2 antibodies. The data with respect to its inhibitory effects
obtained with Western Blot and immunohistochemical co-localization
methods were analyzed and compared between these two cell lines.
The dose of resveratrol selected for the study was determined from an
earlier study.
Results: The results show that both of the pancreatic cancer cell lines are
susceptible to inhibitory effects of this compound. However their relative
effects differed. The proliferative effects of these cultured cells in
response to nicotine appeared to have been mediated by oxidant
activates and these effects were reversed by this dose of resveratrol.
Conclusions: We conclude from our study that the anti-carcinogenic
effects of resveratrol are closely associated with its antioxidant activity in
both human and rat pancreatic tumor cells. Further studies will be
conducted to determine the chemo preventive role of this compound in
transgenic pancreatic cancer model.
Acknowledgements: Through UAMS Foundation and in part by Arkansas
Space Grant Consortium.
A8
Screening for lung cancer with Low-Dose Computed Tomography:
a systematic review of the evidence
Sotiria-Maria E Iliopoulou1,2*, Antonis A Kousoulis2,3
1
Medical School, National and Kapodistrian University of Athens, Athens, 115
27, Greece; 2Society of Junior Doctors, Athens, 15123, Greece; 3Department
of Public Health, Imperial College London, London, SW7 2AZ, UK
Background: Tobacco use is the principal risk factor for lung cancer.
Lung cancer is the most common cause of cancer death worldwide.
When identified clinically, most patients have advanced disease with poor
prognosis: the mortality rate at stage IV is over 95.0%, whereas the 5-year
survival rate is over 73.0% at stage I. Thus, there is a growing interest in
the early detection of lung cancer with Low-Dose Computed Tomography
(LDCT) scans. The objective of the study is to conduct a systematic
review of the evidence in Randomized Clinical Trials (RCTs) assessing the
effect of screening with LDCT on lung cancer mortality and assess benefit
and harm.
Materials and methods: PubMed was our data source (search period:
November 2002 to September 2013). Of 796 English citations reviewed,
we have included 10 RCTs regarding LDCT screening of high risk
individuals for lung cancer.
Results: The National Lung Cancer Screening Trial recruited 53,454
asymptomatic smokers and ex-smokers between the ages of 55 and 74,
with smoking histories of at least 30 pack-years (most guidelines’ target
population).It found a 20% reduction in lung cancer mortality (95% C.I.:
6.8 - 26.0, p = 0.004) and a 6.7% reduction in all-cause mortality (95% C.I.:
1.2 - 13.6, p= 0.02) in the 3 annual LDCDs arm compared to the three
annual CXRs arm. The smaller European DLCST, MILD, Italung and DANTE
trials, with one to five annual LDCTs, fail to reach a statistically significant
difference in lung-cancer mortality (DANTE: RR: 0.97;95% CI, 0.71-1.32;
p=.84; DLCST:RR, 1.15; 95% CI, 0.83-1.61;p=.43); the same was the case
with the MILD trial with one or two annual LDCTs. The small Depiscan
trial and the trial by Garg et al. (LDCT vs CXR and no screening
respectively) with short follow-up periods reported higher detection rates
of non-calcified nodules in the LDCT arm. The biggest so far European
clinical trial N.E.L.S.O.N. with three rounds of LDCT screening has the
purpose to determine whether CT screening will reduce lung cancer
mortality by at least 25%. This, as well as the UKLS trial and the German
LUCI trial, is not yet completed.
Conclusions: There is a big heterogeneity in the findings and the
frequency of false positive results (10%-96.4%), the detection rates, the
number of LDCTs performed (one to fine annually), the sensitivity of
screening (up to 94%), follow-up period (33 months to 10 years), further
assessment of nodules, cost-effectivess, types of biases and the grade of
compliance among participants. Individuals at high risk of developing
lung cancer who meet the criteria for CT should consult their physicians
in order to make a conscious decision about following the current
guidelines. However, results from new studies will provide further insight.
Page 4 of 14
A9
Exhaled carbon monoxide as a marker of lung aging in smokers
presenting with mild air flow limitation
Marios Kougias*, Maria Takousi, Aristea Baschali, Christina Goga, Nikolaos Tatsis,
Stavroula Boulia, Evangelos Balis, George Tatsis
Smoking Cessation Department, Pulmonology Clinic, Evaggelismos General
Hospital, Athens, 10676, Greece
Background: The measurement of exhaled carbon monoxide (CO) level
may provide an immediate, noninvasive method of assessing smoking
status. In addition CO is a molecule generally presumed to be a marker
of oxidative stress and inflammation when endogenously produced. Many
reports have focused on increased endogenous CO production in
pulmonary diseases, including asthma and COPD. The purpose of our
study is to highlight special characteristics in smokers with mild airflow
limitation, in correlation with exhaled CO measurements.
Materials and methods: The exhaled CO levels were measured in
29 smokers (18 women),of mean age 50.62 ± 9.55 smoking 43.28 ± 29.50
pack years presenting at the smoking cessation office of Evaggelismos
Hospital. A thorough smoking history was obtained focusing on smoking
use, dependence and motivation to quit. Exhaled CO measurement was
performed using the piCO+™ Smokerlyzer (Bedfont Instruments; Kent, UK),
which also allows the accurate estimation of the percentage of
hemoglobin attached to CO(HBCO). Spirometry was performed in all
individuals according to ATS criteria, and all participants measured
FEV1>80% of predicted. Data were analyzed using descriptive statistics
and Spearman correlation analysis.
Results: FEV1 measured 89.28% ± 3.84 FVC measured 94.63% ± 3.55 and
MMEF measured 65.02% ± 5.79. CO measured 25.48ppm ± 2.90. HBCO
was estimated at 4.71% ± 0.45. Results are expressed as mean ±SE.
Exhaled CO correlated with age of measured subjects (correlation
coefficient -0.379 at p=0.01 double-sided). HBCO also correlated with age
(correlation coefficient -0.387 at p=0.01 double-sided).
Conclusions: Exhaled CO is a noninvasive method of smoking status but
is also a marker of oxidative stress and inflammation .Correlation of CO
measurement with the age of smokers may provide an insight in the
inflammatory process of smoking, in smokers not presenting with severe
airflow limitation, and provide a marker of lung aging in smokers.
Exhaled CO besides a method for assessing smoking status may provide
useful information of lung aging due to lung inflammation, in smokers
with mild airflow limitation.
A10
Exploring the development of asthma in children with parental and in
utero exposure to smoking
Eleni Xanthopoulou1,2*, Antonis A Kousoulis1,3
1
Society of Junior Doctors, Athens, 15123, Greece; 2Medical School, National
and Kapodistrian University of Athens, Athens, 115 27, Greece; 3Centre for
the History of Science, Technology and Medicine, Imperial College London,
London, SW7 2AZ, UK
Background: Second-hand smoking is a well-established asthma trigger
and a risk factor for new asthma cases in infants. Aim of this review is to
describe the effects of passive smoking exposure on children with
asthma, as well as the impact of maternal smoking during pregnancy on
the development of asthma in children.
Materials and methods: We performed an electronic search in PubMed
and Google Scholar and ginasthma.org using combinations of the main
keywords: asthma, tobacco, smoking, and children. Our search was
focused on the recent literature, between 2008 and 2013.
Results: A significant number of studies have explored the topic in
question in the recent years. There is increasing evidence that passive
exposure to parental smoking is associated with asthma symptoms
among children, as well as more severe disease among children with
already diagnosed asthma. Children with asthma exposed to smoking at
home tend to have more severe and frequent respiratory symptoms,
more asthma-related doctor visits and a detrimental response to asthma
therapy. Exposure to tobacco products diminishes asthma control,
causing poorer response to inhaled corticosteroids, oral steroids and
leukotriene receptor antagonists. Moreover, maternal smoking during
pregnancy increases the risk of developing asthma. Newborns of mothers
who have been smokers have altered cellular immune function and, as a
result, decreased innate production of antigen-presenting cell cytokines
and diminished response to TLR ligands. In utero-exposure to smoke
causes additionally a predisposition to Th2-associated respiratory diseases
and an increased risk for IgE-mediated sensitization.
Conclusions: Second-hand smoking causes both a significant worsening
and an increased number of asthma exacerbations in children with
established disease. Moreover, it constitutes a risk factor for developing
asthma in children with a predisposition to the disease. Finally, it seems
to rank among the predisposing factors for asthma and other atopic
diseases on offspring exposed to tobacco during fetal period.
A11
Periodontal disease of secondhand smoking patients
Arzu Beklen1,2*, Deniz Uckan3, Gulten Tsaous Memet4
1
Department of Periodontology, Faculty of Dentistry, Osmangazi University,
Eskisehir, 26480, Turkey; 2Institute of Biomedical Engineering, Bogazici
University, Istanbul, 34684, Turkey; 3Medico-social Centre, Dental Clinic,
Bogazici University, Istanbul, 34684, Turkey; 4Tepebasi Oral and Dental Health
Hospital, Ankara, 06400, Turkey
Background: Our cross-sectional study investigated associations of
cumulative exposure to secondhand smoke and duration of smoking
cessation with periodontitis among family members. Furthermore the
effects of other risk factors on these associations were analyzed as well.
Materials and methods: In total 109 patients were analyzed with their
full mouth periodontal examination. The groups were divided as current
second hand smokers, former second hand smokers and non-smokers.
The associations between periodontitis occurrence and potential risk
factors was analyzed using univariate and multivariate analysis.
Results: The results showed that the rates of periodontitis among
nonsmokers, former second hand smokers, and current second hand
smokers were 19.5%, 22.3%, 37.4% respectively. We then adjusted the
other periodontal risk factors and we found that the odds ratio (95%
confidence interval) for periodontitis was 2.12 for former second-hand
smokers and 3.56 for current second hand smokers.
Conclusions: In summary, not only a significant dose-response relationship
between pack-years of second hand smoking and periodontitis presence
was observed, but also a significant decrease in the occurrence of
periodontitis was observed in second hand smoke stopped group.
Acknowledgements: The authors declare no conflict of interests and
thank their institutes for the support. The skillful technical help of
Dr. Elif B. Barto is thankfully acknowledged.
A12
Effectiveness of the Tobacco Tactics program in the Department of
Veterans Affairs
Sonia A Duffy1,2,3,4*, David Ronis2, Carrie A Karvonen-Gutierrez1, Lee A Ewing1,
Gregory W Dalack4, Patricia M Smith5, Timothy P Carmody6, Thomas Hicks7,
Christopher Hermann8, Pamela Reeves8, Petra Flanagan9
1
Ann Arbor VA Center for Clinical Management Research, Health Services
Research and Development, Ann Arbor, Michigan, 48105, USA; 2School of
Nursing, University of Michigan, Ann Arbor, Michigan, 48105, USA;
3
Department of Otolaryngology, University of Michigan, Ann Arbor,
Michigan, 48105, USA; 4Department of Psychiatry, University of Michigan,
Ann Arbor, Michigan, 48105, USA; 5Northern Ontario School of Medicine,
Lakehead University, Sudbury, Ontario, P3E 2C6, Canada; 6San Francisco VA
Medical Center, San Francisco, California, 94121, USA; 7Richard L. Roudebush
VA Medical Center, Indianapolis, 46202, USA; 8John D. Dingell VA Medical
Center, Detroit, Michigan, 48201, USA; 9VA Ann Arbor Healthcare System,
Ann Arbor, Michigan 48105, USA
Page 5 of 14
Background: Smoking cessation interventions during hospitalization have
been shown to be efficacious, yet are rarely incorporated into practice.
The purpose of this study was to determine the effectiveness of the
Tobacco Tactics program in three Veterans Affairs (VA) hospitals.
Materials and methods: In this quasi-experimental pre- post- comparison
effectiveness trial, inpatient nurses were educated to provide the
Tobacco Tactics intervention in the Ann Arbor, MI and Detroit, MI VA
hospitals, while the Indianapolis, IN VA hospital was the control site
(N=1,070). The Tobacco Tactics nurse toolkit included: 1) one contact
hour for training; 2) a PowerPoint presentation on behavioral and
pharmaceutical interventions; 3) a pocket card “Helping Smokers Quit:
A Guide for Clinicians”; 4) pharmaceutical and behavioral protocols; and
5) a computerized template for nurse documentation. The patient toolkit
included: 1) a brochure; 2) a videotape “Smoking: Getting Ready to Quit;”
3) a Tobacco Tactics manual; 4) pharmaceuticals; 5) a 1-800-QUIT-NOW
help line card; and 6) post-discharge telephone calls. Smoking patients
were surveyed in the hospital and again six-months post-discharge.
Urinary cotinine tests were used to verify six-month smoking status.
Results: The average age was 55.3 years, most were male (94%) and not
married (76%). After adjustment for the propensity of being assigned to
treatment condition, there were significant improvements in 6-month quit
rates in the pre- to post-intervention time periods in Ann Arbor (p=0.004)
and Detroit (p<0.001) compared to the Indianapolis control site. The
intervention was particularly effective in Detroit where pre-intervention quit
rates were 4% compared to 13% post-intervention.
Conclusions: This study showed that training staff nurses to integrate
smoking cessation services into their routine care may increase quit rates.
The Tobacco Tactics program, which meets the newly released (2011) Joint
Commission standards that apply to all inpatient smokers, has the potential
to significantly decrease smoking among patients admitted to VA hospitals.
Acknowledgements: Funding was supported by the Department of
Veterans Affairs Service Directed Project (SDP 06-003).
A13
Randomized controlled trial of the Tobacco Tactics website versus
1-800-QUIT-NOW telephone line among Operating Engineers
Seung Hee Choi1, Andrea H Waltje1, David L Ronis1, Devon Noonan2,
Oisaeng Hong3, Caroline Richardson4,5, John D Meeker6, Sonia A Duffy1,4,7,8*
1
School of Nursing, University of Michigan, Ann Arbor, Michigan, 48105, USA;
2
School of Nursing, Duke University, Durham, North Carolina, 27708, USA;
3
Department of Community Health Systems, University of California, San
Francisco, California, 94143, USA; 4Ann Arbor VA Center for Clinical
Management Research, Health Services Research and Development, Ann
Arbor, Michigan, 48105, USA; 5Department of Family Medicine, University of
Michigan, Ann Arbor, Michigan, 48105, USA; 6School of Public Health,
University of Michigan, Ann Arbor, Michigan, 48105, USA; 7Department of
Otolaryngology, University of Michigan, Ann Arbor, Michigan, 48105, USA;
8
Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,
48105, USA
Background: The purpose of this study was to evaluate the efficacy and
usage of the Tobacco Tactics website compared to the 1-800-QUIT-NOW
telephone line among Operating Engineers (heavy equipment operators).
Materials and methods: Smokers attending workplace safety training
groups were randomized to either the Tobacco Tactics website with
nurse phone counseling and access to nicotine replacement therapy
(NRT) or to the 1-800-QUIT-NOW telephone line which provided an equal
number of phone calls and NRT. Participating Operating Engineers
completed a baseline survey as well as mailed surveys at 30-days and
6-months. Urinary cotinine tests were used to verify 6-month smoking
status. The outcomes were compared using c2 tests, t-tests, mixed
models, generalized mixed models, and logistic regression models.
Results: Compared to participants in the 1-800-QUIT-NOW group,
significantly more of those in the Tobacco Tactics website group
participated in the intervention, received phone calls and found the
intervention helpful (p<0.05). Seventy percent of the website group
received NRT compared to 5.1% of the quitline group (p<0.001). At
30-day follow-up, the Tobacco Tactics website group showed significantly
higher quit rates (26.9%) than the 1-800-QUIT-NOW group (7.7%)
(p<0.05), but this difference was no longer significant at 6-month
follow-up. There were significantly more positive changes in harm
reduction measures (quit attempts, number of cigarettes smoked per day,
and nicotine dependence) at both 30-day and 6-month follow-up in the
Tobacco Tactics website group compared to the 1-800-QUIT-NOW group
(p<0.05).
Conclusions: The Tobacco Tactics website showed higher efficacy and
reach than the 1-800-QUIT-NOW intervention. Longer counseling sessions
may be needed to improve 6-month cessation rates. This intervention has
the potential to reduce morbidity and mortality among Operating
Engineers.
Acknowledgements: This work was supported by the Blue Cross Blue
Shield of Michigan Foundation (BCBSM) Grant Number N011646-1465.RFP
and the National Institutes of Health (NIH) Grant Number 5R21CA152247-02.
A14
Smoking alters the antigenicity and infectivity of Porphyromonas
gingivalis
Iris Zeller1, Justin A Hutcherson1, Richard J Lamont1,2, Donald R Demuth1,
Pinar Gumus3, Nejat Nizam3, Nurcan Buduneli3, David A Scott1*
1
Oral Health and Systemic Disease, University of Louisville, Louisville,
Kentucky, 40292, USA; 2School of Dentistry, University of Louisville, Louisville,
Kentucky, 40292, USA; 3Department of Periodontology, School of Dentistry,
Ege University, Izmir, 35040, Turkey
Background: Cigarette smokers are more susceptible to periodontal
diseases and are more likely to be infected with Porphyromonas gingivalis
than non-smokers. Furthermore, smoking is known to alter the expression
of P. gingivalis surface components and to compromise IgG generation.
The aim of this study was to evaluate if the overall IgG response to
P. gingivalis is suppressed in smokers in vivo and if previously established
in vitro tobacco-induced phenotypic P. gingivalis changes would be
reflected in vivo.
Materials and methods: We examined the humoral response to several
P. gingivalis strains as well as specific tobacco-regulated outer membrane
proteins (FimA and RagB) by ELISA in biochemically-validated (salivary
cotinine) smokers and non-smokers with chronic (CP, n = 13) or aggressive
(AP, n = 20) periodontitis. We also monitored the local and systemic
presence of P. gingivalis DNA by PCR.
Results: Smoking was associated with decreased total IgG responses
against clinical (10512, 5607, and 10208C; all p < 0.05) but not laboratory
(ATCC 33277, W83) P. gingivalis strains. Smoking did not influence IgG
produced against specific cell surface proteins, although a non-significant
pattern towards increased total FimA-specific IgG in CP subjects, but not AP
subjects, was observed. Seropositive smokers were more likely to be
infected orally and systemically with P. gingivalis (p < 0.001), as determined
by 16S RNA analysis.
Conclusions: Smoking alters the humoral response against P. gingivalis
and may increase P. gingivalis infectivity, strengthening the evidence that
mechanisms of periodontal disease progression in smokers may differ from
non-smokers with the same disease classification.
Acknowledgements: This study was funded by NIDCR (R01DE019826
to DAS).
A15
Nicotinic augmentation of anti-inflammatory GSK3b signaling
David A Scott*, Richard J Lamont, Akhilesh Kumar, Huizhi Wang
School of Dentistry, University of Louisville, Louisville, Kentucky, 40292, USA
Background: Glycogen synthesis kinase 3b (GSK3b) has been shown to
be a critical mediator of the intensity and direction of the innate immune
system responding to bacterial stimuli. Stimulation of the anti-cholinergic
anti-inflammatory system by tobacco alkaloids (nicotine; cotinine) leads to
phosphorylation and inactivation of GSK3b and, subsequently, to immune
suppression. This presentation will review the tobacco-induced
dysregulation of GSK3b signaling and provide insight into the increased
Page 6 of 14
susceptibility of smokers to multiple bacterial diseases, including those
caused by Mycobacterium tuberculosis, Legionella pneumophila, and
Neisseria meningitidis. The extensive ongoing efforts to exploit GSK3b for
its therapeutic potential in the control of infectious diseases will also be
reviewed.
A16
Prevalence and determinants of SHS exposure in public and private
areas after the 2010 smoke-free legislation in Greece
Sotiria Schoretsaniti1*, Filippos T Filippidis1, Constantine I Vardavas2,3,4,
Chara Tzavara1, Christine Dimitrakaki1, Panagiotis Behrakis3,4,5,
Gregory N Connolly2, Yannis Tountas1
1
Center for Health Services Research, Department of Hygiene, Epidemiology
and Medical Statistics,School of Medicine, National and Kapodistrian
University of Athens, Athens, 11527, Greece; 2Center for Global Tobacco
Control, Department of Social and Behavioral Sciences, Harvard School of
Public Health, West Boston, 02115, Massachusetts, USA; 3Smoking and Lung
4
Foundation for Biomedical Research of the Academy of Athens, Athens, 115
27, Greece; 5Department of Environmental Health, Harvard School of Public
Health, 677 Huntington Avenue Landmark, West Boston, MA 02115, USA
Background: The objective of the present survey was to assess the extent
and socioeconomic determinants of population exposure to secondhand
smoke (SHS) in Greece in 2011.
Materials and methods: The national household survey Hellas Health IV
was conducted in October 2011. SHS exposure was based on self-reported
exposure within home, workplace and public places.
Results: 33.1% of the respondents reported living in a smoke-free home.
Smokers (p<0.001) and single individuals (p<0.017) were less likely to
prohibit smoking at home. SHS exposure at work, in restaurants and in
bars/clubs/cafes was frequently mentioned by 41.6%, 84.2% and 90.5%
respectively. SHS exposure in a bar/club/café was noted more among
single individuals (p=0.004) and those aged 18-34 years (p=0.007).
Conclusions: Inhabitants of rural areas were more likely to report
someone smoking indoors in all the above venues. Public health education
and effective enforcement of the nationwide smoke-free legislation are
imperative.
A17
5-year trends in the intention to quit smoking amidst the economic
crisis and after recently implemented tobacco control measures in
Greece
Sotiria Schoretsaniti1*, Filippos T Filippidis1, Constantine I Vardavas2,3,4,
Christine Dimitrakaki1, Panagiotis Behrakis2,3,4, Gregory N Connolly2,
Yannis Tountas1
1
Center for Health Services Research, Department of Hygiene, Epidemiology
and Medical Statistics,School of Medicine, National and Kapodistrian
University of Athens, Athens, 11527, Greece; 2Center for Global Tobacco
Control, Department of Social and Behavioral Sciences, Harvard School of
Public Health, West Boston, 02115, Massachusetts, USA; 3Smoking and Lung
4
Biomedical Research Foundation of the Academy of Athens, Athens, 115 27,
Greece
Background: The objective of the present study was to explore the trends
in the intention to quit smoking among adults in Greece between
2006-2011, a period characterized by financial instability and newly
endorsed tobacco control initiatives.
Materials and methods: Trends analysis of 3 representative national and
cross-sectional surveys, ‘Hellas Health I’ (2006), “Hellas Health III” (2010)
and Hellas Health IV (2011).
Results: Since 2006, the intention to quit smoking has significantly
increased among both genders (33.3% [in 2006] to 42.4% [in 2011],
p=0.002), among respondents aged >54 years (26.9% [in 2006] to 45.1%
[in 2011], p=0.019) and among residents of rural areas (26.4% [in 2006]
to 46.7% [in 2011], p=0.001). Both highest (32.1% [in 2006] to 49.4% [in
2011], p=0.036) and lowest (31.7% to 46.0%, p=0.021) socioeconomic (SE)
strata showed an increase in the proportion of smokers who intend to
quit. However, in 2011, quit attempts were more frequent (35.3%, p=0.009)
in smokers of high socioeconomic status. Moreover, smoking prevalence
has significantly decreased (43.1% [in 2006] to 38.1% [in 2011], p=0.023),
mainly among men (52.4% to 45.7%, p=0.037), respondents of low
socioeconomic status (38.9% to 29.4%, p=0.008) and residents of urban
areas (45.2% to 37.9%, p=0.005).
Conclusions: Over the past 5 years and possibly as a combined result of
the implemented tobacco control policies and austerity measures, the
intention to quit smoking has increased among all SE strata, however
actual quit attempts were higher among those less disadvantaged.
Further effort should be made to support quit attempts, especially among
vulnerable populations.
Acknowledgements: The work was supported by the George D. Behrakis
Foundation through the HEART project (Hellenic Action for Research
against Tobacco).
A18
Smoking cessation prior to elective plastic surgery: why, when and how?
Vasileios Theocharidis1,2*, Konstantinos P Economopoulos1,3
1
Society of Junior Doctors, Athens, 15123, Greece; 2Medical school, National
and Kapodistrian University of Athens, Athens, 115 27, Greece; 3Department
of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, 02114, USA
Background: Tobacco is a serious nuisance in plastic surgery, mainly
through the effects of its inhaled constituents on wound healing
physiology. While there are thousands of chemical compounds in the
inhaled smoke, the most prominent ones are nicotine, carbon monoxide
and hydrogen cyanide, which are partially responsible for impaired wound
healing through decreased oxygen delivery and utilization, and deranged
collagen deposition [1]. Our aim is to summarize the existing literature on
the effects of smoking in various plastic surgical procedures, and on the
correct timing and available methods of preoperative smoking cessation.
Materials and methods: A literature review of PubMed was performed.
The inclusion criteria were: articles on the effects of smoking on wound
healing, plastic surgery and hand surgery, on the timing of preoperative
smoking cessation and on methods of smoking cessation. The search
terms used in combinations were “smoking”, “plastic surgery”, “wound
healing”, “hand surgery”, “smoking cessation”.
Results: In facelift procedures, skin slough is an important complication
and there is a strong association between smoking and higher skin slough
rates [2]. A similar relationship can be identified in abdominoplasty, as
smokers suffer from a higher percentage of wound healing complications
[3]. Complications like T-junction necrosis and infections were also higher
in smokers who underwent breast reduction [4]. Regarding breast
reconstruction, two studies showed higher rates of reconstructive failure
and overall complications in smokers [5]. However, no significant difference
was found regarding flap loss and vascular thrombosis between smokers
and non-smokers [6]. In microsurgical free flap transfer, the relationship
visited above is prevalent, with higher wound healing-related complication
rates for smokers. [7]. In hand surgery, it has been shown that smoking
post-replantation decreases digital blood flow significantly [8]. A metaanalysis showed the detrimental effect of smoking on the success rate of
digit replantation (61.1% in smokers vs. 96.7% in non-smokers) [9]. While
there is no consensus regarding the optimal smoke-free period
preoperatively, many authors agree that 4 weeks are capable of reducing
the rates of smoking-related complications satisfactorily. Some authors
support the use of cotinine measurement, as patient history can prove
notoriously inaccurate [10]. In order to improve the low cessation rate
achieved by no intervention (about 1 in 8) [11], nicotine replacement
therapy and medication can be used effectively [12].
Conclusions: Smoking is an independent risk factor for wound healing
complications, but not for free flap loss. Smokers who are candidates for
plastic surgery should cease smoking for an adequate amount of time
preoperatively. Nicotine replacement therapy and medication are effective
in assisting their smoking cessation efforts.
Page 7 of 14
References
1. Silverstein P: Smoking and wound healing. Am J Med 1992, 93(1a):22-24.
2. Rees TD, Liverett DM, Guy CL: The Effect of Cigarette Smoking on
Skin-Flap Survival in the Face Lift Patient. Plastic and Reconstructive
Surgery 1984, 73(6):911-915.
3. Manassa EH, Hertl CH, Olbrisch RR: Wound Healing Problems in Smokers
and Nonsmokers after 132 Abdominoplasties. Plastic and Reconstructive
Surgery 2003, 111(6):2082-2087.
4. Bikhchandani J, Varma SK, Henderson HP: Is it justified to refuse breast
reduction to smokers? Journal of plastic, reconstructive & aesthetic
surgery. JPRAS 2007, 60(9):1050-1054.
5. McCarthy CM, Mehrara BJ, Riedel E, Davidge K, Hinson A, Disa JJ,
Cordeiro PG, Pusic AL: Predicting complications following expander/
implant breast reconstruction: an outcomes analysis based on
preoperative clinical risk. Plast Reconstr Surg 2008, 121(6):1886-92.
6. Chang DW, Reece GP, Wang B, Robb GL, Miller MJ, Evans GR, Langstein HN,
Kroll SS: Effect of smoking on complications in patients undergoing free
TRAM flap breast reconstruction. Plast Reconstr Surg 2000, 105(7):2374-80.
7. Chang LD, Buncke G, Slezak S, Buncke HJ: Cigarette smoking, plastic
surgery, and microsurgery. J Reconstr Microsurg 1996, 12(7):467-74.
8. Van Adrichem LN, Hovius SE, van Strik R, van der Meulen JC: The acute
effect of cigarette smoking on the microcirculation of a replanted digit.
J Hand Surg Am 1992, 17(2):230-4.
9. Dec W: A meta-analysis of success rates for digit replantation. Tech Hand
Up Extrem Surg 2006, 10(3):124-9.
10. Payne CE, Southern SJ: Urinary point-of-care test for smoking in the
pre-operative assessment of patients undergoing elective plastic
surgery. J Plast Reconstr Aesthet Surg 2006, 59(11):1156-61.
11. Rinker B: The evils of nicotine: an evidence-based guide to smoking and
plastic surgery. Ann Plast Surg 2013, 70(5):599-605.
12. Mahvan T, Namdar R, Voorhees K, Smith PC, Ackerman W: Clinical Inquiry:
which smoking cessation interventions work best? J Fam Pract 2011,
60(7):430-1.
A19
From the classroom to Facebook: a modern approach for smoking
education in adolescents
Antonis A Kousoulis1,2*, Stylianos P Kympouropoulos2,3, Dimitra K Pouli2,4,
Konstantinos P Economopoulos2,5, Constantine I Vardavas6
1
Clinic of Social and Family Medicine, Medical School, University of Crete,
Heraklion, 71003, Greece; 2Society of Junior Doctors, Athens, 15123, Greece;
3
Department of Psychiatry, General University Hospital “ATTIKON”, Athens,
Greece; 4School of Medicine, National and Kapodistrian University of Athens,
Athens, 115 27, Greece; 5Department of Surgery, Massachusetts General
Hospital, Harvard Medical School, Boston, Massachusetts, 02114, USA; 6Center
for Global Tobacco Control, Department of Social and Behavioral Sciences,
Harvard School of Public Health, Boston, Massachusetts, 02114, USA
Background: Although studies show that a large majority of smokers
initiate smoking while in early adulthood, poor efficacy of school smokingprevention programs has been noted. With the explosive rise in internet
use, the imperative need to use new forms of media for educational
purposes has emerged more prominently than ever before. In this paper
we briefly describe the design and testing of a smoking-related social
media-integrated education intervention.
Materials and methods: We describe 5 simple steps towards a successful
presentation that will lead to meaningful social media interactions: Steps 1-3
include the careful selection of the presenters and their education on
general presentation techniques and classroom behaviors, as well as the
topic in particular. During step 4, the presenters link up with the students
using a social media platform, and provide “take-home” key points.
Facebook is chosen as the most popular social networking website in which
the vast majority of youth is daily active and already has accounts. Finally, in
step 5, the presenters request the attendees to upload one of the take
home messages as their Facebook status. The rationale is that the
knowledge could, thus, reach a quite larger number of young people than
the finite number of attendees.
Results: We implemented and tested the above algorithm during a
tobacco control lecture curriculum to 225 high school students in Athens,
Greece, in May 2012. After the lecture, a 3-day window was provided to
the attendees to connect with the presenters in Facebook and post
a smoking-related sentence in their account status. Assessed 72hrs later,
32 students (14.2%) had posted a smoking-related sentence in their
Facebook account, a “take-home message” that was spread to their
20,095 cumulative friends as a note on their wall via newsfeed.
Conclusions: Our research describes a successful implementation of an
educational intervention on smoking in high school students. Should an
educational or community based campaign utilize a Facebook function and
systematize this algorithm within a number of schools, the take-home
messages heard from the always influential lips of their peers, could reach
literally the entire community of adolescents and presumably lead to social
sensitization through offline networks that have an online representation.
This algorithm and its preliminary implementation adds to the limited
existing evidence on how social media may advance tobacco control, and
provides insight into a novel way of providing health information to youth,
a hard to reach and vulnerable population.
A20
Maternal tobacco use during pregnancy and risk of congenital heart
defects in offspring: a systematic review
Aspasia Tzani1,2*, Konstantinos P Economopoulos1,3
1
Society of Junior Doctors, Athens, 15123, Greece; 2Medical school, National
and Kapodistrian University of Athens, Athens, 115 27, Greece;
3
Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, 02114, USA
Background: Numerous human studies have investigated potential
teratogenic effects of maternal smoking during pregnancy, with
conflicting findings [1,2]. One of the most common birth malformations is
congenital heart defect (CHD) with a prevalence of around 1% of live
births [3,4]. More specifically, several studies indicate that maternal
tobacco use is related with increased risk of CHD, whereas other studies
do not find any association [5,6]. The aim of this study is to systematically
review the literature regarding the correlation between maternal smoking
during pregnancy and the prevalence of CHDs in offspring.
Material and methods: A thorough up-to-date search of the English
literature through PubMed identified studies of maternal smoking during
pregnancy and CHD in infants. The selected Mesh terms included
”maternal”, “tobacco”, “smoking”, ”cigarette”, “pregnancy”, “cardiovascular”,
“abnormalities” ”congenital abnormalities”, “congenital heart defect”,
”offspring”. The main parameters that were extracted from the eligible
studies were maternal characteristics (age, weight, race, socioeconomic and
health status), smoking habits (cigarettes per day, fetal exposure period)
and CHD subtypes.
Results: The systematic search identified 874 articles, of which 37 met the
inclusion criteria. Most studies have shown a strong correlation (OR: 2.06;
95% CI: 1.20–3.54) between mothers who reported medium and heavy
smoking (≥1 pack per day) during the first semester of pregnancy and
infants with septal heart defects than women who did not smoke during
this time period. Maternal age, weight and socioeconomic status are
independent confounding factors for neonatal heart defects. Women who
smoked ≥25 cigarettes per day had increased risk to have infants with
right-sided obstructive defects compared with nonsmoking mothers.
Infants with CHD were more likely to be premature and have lower birth
weight than healthy infants.
Conclusions: Maternal cigarette smoking during pregnancy is associated
with congenital heart defects, especially with septal and right-side
obstructive defects [7]. Additionally, future studies should take place in
order to understand all underlying mechanisms and set the starting point
of population-based prevention strategies so as to encourage more
women to quit smoking before or early in pregnancy resulting in
decreased infant mortality and morbidity.
References
1. Kallen K: Maternal smoking and congenital heart defects. Eur J Epidemiol
1999, 15:731-737.
2. Karatza AA, Giannakopoulos I, Dassios TG, Belavgenis G, Mantagos SP,
Varvarigou AA: Periconceptional tobacco smoking and isolated congenital
heart defects in the neonatal period. Int J Cardiol 2011, 148:295-299.
Page 8 of 14
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4.
5.
6.
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Yerushalmy J: Congenital heart disease and maternal smoking habits.
Nature 1973, 242:262-263.
Hackshaw A, Rodeck C, Boniface S: Maternal smoking in pregnancy and
birth defects: a systematic review based on 173,687 malformed cases
and 11.7 million controls. Hum Reprod Update 2011, 17:589-604.
Perspectives in pediatric cardiology. Epidemiology of congenital heart
disease. The Baltimore-Washington Infant Study 1981–1989. New York:
Futura Pub, Mount Kisco: Ferencz C, Rubin JD, Loffredo CA, Magee CA
4:1993-last page.
Kuciene R, Dulskiene V: Maternal socioeconomic and lifestyle factors
during pregnancy and the risk of congenital heart defects. Medicina
Kaunas 2009, 45:904-909.
Malik S, Cleves MA, Honein MA, Romitti PA, Botto LD, Yang S, Hobbs CA:
National Birth Defects Prevention Study: Maternal smoking and
congenital heart defects. Pediatrics 2008, 121:e810-e816.
A21
Analysis of acceptance of the smoking ban in Greece
Efthimios Zervas1*, Nikolaos Papantonis1, Eleni Ischaki2, Eleni Litsiou2,
Paraskevi Katsaounou2
1
School of Science and Technology, Hellenic Open University, Greece;
2
Pulmonary department-ICU, Εvaggelismos Hospital, Athens, 10676, Greece
Background: Exposure to secondhand smoke, according to the World
Health Organization is responsible for 603,000 deaths in 2004. The ban on
smoking in public places in Greece was legislated but not implemented, as
the adequate and effective measures were not taken. This study aims to
determine the degree of acceptance of the last anti-smoking law and the
parameters associated with the acceptance or not of the smoking ban.
Materials and methods: The survey was based on 540 valid questionnaires
collected between February and April 2011 in Attica. The statistical
analysis is initially focused on the mean value and the distribution of
responses concerning the smoking habits and the views about smoking
restriction in enclosed public places. Then, the responses between
smokers and non-smokers are separated and the correlation of
responses with the personal data of respondents and between them is
performed.
Results: 42% of respondents are smokers and 20% of them have a high
degree of dependence. Only 9% of respondents consider that the
measures are sufficient for the protection of non-smokers, while 65%
agreed to a total smoking ban in enclosed spaces. 50% believe that the
law will not be implemented. 66% believe that the ban would not affect
the number of cigarettes smoked and do not consider that this ban leads
to social discrimination against smokers. 75% believe that the smoking
ban will affect their mode of entertainment. In all questions the ban
acceptability of smokers is reduced compared to non-smokers and also
depending on the degree of addiction to smoking. The ban acceptance
increases with the educational level.
Conclusions: The Greek public, including smokers, is mature to accept the
ban on smoking in public places. The respondents wait for the political will
to implement this ban and the higher information of the public about the
effects of passive smoking.
A22
The importance of early COPD diagnosis during a smoking cessation
program
Eleni Ischaki*, Eleni Litsiou, Vasiliki Saltagianni, Ioanna Nikoloutsou,
Aikaterini Tsoutsa, Andreas Asimakos, Spyros Zakynthinos,
Paraskevi Katsaounou
Pulmonary and Critical Care Department, Evangelismos Hospital, Athens,
10376, Greece
Background: Many patients with mild–moderate COPD (chronic obstructive
pulmonary disease), are asymptomatic. Since expressed symptoms are
usually mild and mostly attributed to age, they are often underestimated
[1,2]. Thus early COPD patients usually remain undiagnosed [3]. The aim of
Page 9 of 14
the study is to evaluate the rates of undiagnosed COPD cases in early stages
of the disease (stage I and II according to GOLD classification), [4] in our
smoking cessation program and to assess the effectiveness of COPD
diagnosis as a motivational tool for quitting smoking.
Materials and methods: 551 current smokers, aged ≥18 years old,
attended voluntarily the smoking cessation program in our outpatient
smoking cessation clinic. All smokers performed spirometry. Behavioral
counseling and pharmacotherapy with varenicline were administered to
all participants.
Results: During the study, 85 of 551 smokers were diagnosed for COPD.
Only 5 of them were previously diagnosed with the disease (2 in stage II,
2 in stage III and 1 in stage IV). None of them reported symptoms.
Smoking abstinence rates at 3 months was recorded. Overall smoking
cessation rates three months after behavioral counseling was 55% (n=303).
This percentage was higher in first diagnosed COPD patients, as shown
in Table 1.
Conclusions: A smoking cessation program is a great opportunity to
identify undiagnosed COPD cases. COPD diagnosis is an effective motive to
quit smoking. Smoking cessation combined with treatment based on
COPD severity can modify the progression of the disease. Namely the rate
of yearly FEV1 decline and COPD exacerbations are reduced after smoking
cessation and patients’ health related quality of life is improved. The above
effects are maximized when smoking cessation is achieved in early COPD
stages [5,6]
References
1. Akamatsu K, Yamagata T, Kida Y, Tanaka H, Ueda H, Ichinose M: Poor
sensitivity of symptoms in early detection of COPD. COPD 2008,
5(5):269-73.
2. Buffels J, Degryse J, Heyrman J, Decramer M, DIDASCO Study: Office
spirometry significantly improves early detection of COPD in general
practice: the DIDASCO Study. Chest 2004, 125(4):1394-9.
3. Miravitlles M, Soriano JB, García-Río F, Muñoz L, Duran-Tauleria E,
Sanchez G, Sobradillo V, Ancochea J: Prevalence of COPD in Spain: impact
of undiagnosed COPD on quality of life and daily life activities. Thorax
2009, 64(10):863-8.
4. Global Strategy for the diagnosis, management and prevention of
Chronic Obstructive Pulmonary Disease. Global initiative for chronic
Obstructive Lung Disease (GOLD) 2012.
5. Decramer M, Cooper CB: Treatment of COPD: the sooner the better?
Thorax 2010, 65(9):837-41.
6. Price D, Freeman D, Cleland J, Kaplan A, Cerasoli F: Earlier diagnosis and
earlier treatment of COPD in primary care. Primary Care Respiratory
Journal 2011, 20(1):15-22.
A23
Economic crisis and smoking in health professionals in Greece
Eleni Litsiou1*, Aikaterini Tsoutsa1, Vasiliki Saltagianni1, Dimos Fotopoulos2,
Stavroula Kolokytha1, Spyridon Zakynthinos1, Paraskevi Katsaounou1
1
Pulmonary department-ICU, Εvaggelismos Hospital, Athens, 10676, Greece;
2
OKANA, Addiction Unit, Rethymnon, 74100, Greece
Background: Despite the reduction of consumer disposable income due
to the economic crisis which negatively affected tobacco (Euromonitor,
2012), the proportion of smokers in Greece is still the highest among all
European Countries (42.0%). This percentage is even high in medical
students (35.0%) and professionals [1,2].
Table 1(abstract A22) COPD smokers that attended our
Smoking Cessation Clinic
COPD stages
n
First diagnosis
Abstinence rates after 3
months*
*
Ι
ΙΙ
ΙΙΙ
IV
39
39
35
33
11
9
1
0
30
(76.9%)
30
(85.79%)
7
(63.6%)
1
(100%)
Abstinence rates are referred to the summation of old and new COPD cases
Materials and methods: In our study, we investigated how occupational
factors and economic crisis affect smoking in health professionals in
Evaggelismos Hospital (the largest in Greece). Our questionnaires included
smoking history, demographic factors, working data, intention to quit and
4DSQ (measuring depression anxiety and related psychosomatic
symptoms). In our sample of 500 participants (men/women=1:4, 37.0%
medical doctors, 58.0% nurses), 49.0% were smokers. Initially, we explored
work factors affected by crisis. The amount of work has increased for 45%
of workers with a parallel decrease of 10.0-20.0% in the income of 90.0%.
After collecting the questionnaires we distributed informative leaflets about
our Smoking Cessation Outpatient Clinic (SCC).
Results: Taking into account that a smoker (1 pack/d) spends on average
10.0-20.0% of his salary for smoking, it is a paradox that only 25.0% of them
report an intention to quit. This could be explained because smokers
addicted to nicotine use smoking for handling stress and depression.
Consequently, our SCC focused in informing the staff that nicotine is a
stimulant agent and thus is wrongly interpreted as relaxant. We initiated a
cognitive intervention-motivational coaching program in order to stop this
vicious circle. Namely to dissociate smoking used for craving and alleviation
of withdrawal symptoms from real-life stress. After being informed, 30.0% of
smokers intend attempting smoking cessation in our clinic.
Conclusions: Further information and intervention programs are necessary
so that smokers are convinced that nicotine is a stimulant agent and thus
is wrongly interpreted as relaxant.
Acknowledgements: Excellence 2012
References
1. Caleyachetty A, Lewis S, McNeill A, Leonardi-Bee J: Struggling to make
ends meet: exploring pathways to understand why smokers in financial
difficulties are less likely to quit successfully. Eur J Public Health 2012,
22(1):41-8.
2. Vardavas CI, Bouloukaki I, Linardakis MK, Tzilepi P, Tzanakis N, Kafatos AG:
Smoke-free hospitals in Greece: Personnel perceptions, compliance and
smoking habit. TobInduc Dis 2009, 31(5):1-8.
A24
Smoking cessation changes basic metabolism, body weight, leptin and
insulin levels, adipose tissue percentage, index of insulin resistance and
index of insulin secretion
Ioanna Nikoloutsou1, Vasiliki Vasileiou2, Eleni Litsiou1, Stavroula Kolokytha1,
Aikaterini Tsoutsa1, Spyros Zakynthinos1, Paraskevi Katsaounou1*
1
Pulmonary department-ICU, Εvaggelismos hospital, Athens, 10676, Greece;
2
Endocrinology Department, Alexandra hospital, Athens, 11528, Greece
Background: It is known that nicotine increases energy expenditure,
basic metabolism and has appetite-suppressing properties, which likely
explains why smokers tend to have lower body weight than non-smokers
and why smoking cessation is followed by weight gain up to 12 kgr (7kgr
in median). Thus smoking cessation often has the disadvantage of
increasing the risk of metabolic syndrome; fact that both decreases the
benefits of smoking cessation and can discourage smokers (mostly
women) from quitting. On the top of that, weight gain has been found to
increase the risk of relapse, particularly among normal-weight or
underweight women who report chronic dieting, but also among men.
Varenicline is a nicotinic-cholinergic receptor partial agonist and therefore
should share nicotine’s properties. Thus we believe that during its intake
for three months in the process of smoking cessation basic metabolism
will be sustained in levels comparable to these while smoking. During
this period ex-smokers are also protected from withdrawal syndromes
and thus capable of following psychological and physical activity
counselling in order to sustain stable body weight. Quitting smoking is a
process of changing life habits and is extremely difficult due to the
addictive properties of nicotine. Post cessation weight gain decreases the
benefits and leads to increased relaption rates. Varenicline improves
succession and decrease relaption rates.
Materials and methods: During the three months period of varenicline
intake, we enrolled 15 smokers that visited our smoking cessation clinic
and succeeded in quitting smoking. Eight used varenicline. Basic
metabolism and body weight were measured before (BSC) and one month
after smoking cessation (ASC).
Results: Basic metabolism was 1418.4 ± 202 BSC and 1489.2±183 ASC in
smokers that took varenicline and 1390.8 ± 220 BSC and 1250 ± 240 ASC
in smokers that did not use the drug or any nicotine replacement therapy.
Body weight was 79.4± 5 BSC and 81.3 ± 6 in the varenicline group and
74± 6 BSC and 78±5 ASC in the non varenicline group. Minimum weight
increase in ex-smokers that use varenicline will maximize the profits of
smoking cessation on the top of having a higher probability in succeeding
to stop smoking. We also found that ex-smokers not only take extra
weight, but this weight has the following consequences:
1. The percentage of adipose tissue is higher after smoking cessation (from
24.1% to 31.5%).
2. Both levels of leptin and leptin/fat mass were higher after smoking
cessation (from 3318.156 pg/ml to 3384.1pg/ml).
3. Index of insulin resistance (HOMA IR) is higher after smoking cessation
(HOMA IR: from 140.8 to 167.56)
4. Index of insulin secretion (HOMA B) is higher after smoking cessation
(HOMA B: from 951.54 to 1022.75).
Conclusions: Considering that tobacco and obesity are the two leading
causes of preventable death, and since the relationship between tobacco
smoke and metabolic syndrome is confirmed, we should help smokers to
quit, increase the succession rates, decrease the relapse rates and
maximize the benefits of smoking cessation by preventing post cessation
metabolic syndrome.
Acknowledgements: THORAX Foundation.
A25
Treatment of tobacco addiction using the Feeling-State Addiction
Protocol (FSAP) of the Eye Movement Desensitization and Reprocessing
(EMDR) treatment
Aikaterini Tsoutsa*, Dimos Fotopoulos, Spyridon Zakynthinos,
Paraskevi Katsaounou
Pulmonary &Critical Care Department, Evaggelismos Hospital, Athens, 10676,
Greece
Background: Compulsions and cravings for smoking have been the
subject of behavioral treatment. EMDR [1] is an established, effective
treatment of trauma-based disorders [2]. Its use in the treatment of
addictions and compulsions is relatively new. Although there are ways of
targeting irrational positive affect via EMDR [3]. Merging the Feeling-State
Theory of Compulsions and EMDR, the Eye Movement Compulsion
Protocol (EMCP) was developed. EMCP is used for fading both feelings
and un-wanted behavior related to smoking. The FSAP hypothesizes that
the pleasure during smoking is imprinted in the brain generating feelings
like comfort, contentment and happiness [4].Thus, when craving resurges,
the Feeling-State (FS) behavior is re-enacted. The EMCP incorporates the
standard eye movement technique of EMDR to reduce the FS associated
with impulsion to smoke. This study aims to assess the efficacy of the
FSAP in the treatment of tobacco addiction of relapsed smokers with
persistent compulsions to smoke
Materials and methods: We studied 2 groups (12 smokers in each), that
relapsed (at least 1 m after smoking cessation). Smokers were matched for
age, sex, Fagerstrom Test for Nicotine Dependence & pack/d.
Results: The FSAP although brief, results in profound changes in behavior
[4]. Consequently, the 1st group was administered 6 sessions of the FSAP
protocol. The 2nd group had 6 sessions of Cognitive Behavior Therapy. The
2 groups were compared for smoking cessation (self-reported questionnaire,
CO-measurements). The 1st group had a succession rate of 50% vs the
second that had only 25%.
Conclusion: Thus, we conclude that EMDR could be a very helpful tool in
managing smoking relapses.
Acknowledgements: The research was sponsored by Evaggelismos
Hospital.
References
1. Shapiro F: Eye movement desensitization and reprocessing (EMDR):
Basic principles, protocols, and procedures. New York: Guilford Press, 2
2001.
2. Van der Kolk B, Spinazzolla J, Blaustein M, Hopper E, Korn D, Simpson W: A
randomized clinical trial of EMDR, fluoxetine and pill placebo in the
Page 10 of 14
3.
4.
treatment of PTSD: Treatment effects and long-term maintenance.
Journal of Clinical Psychiatry 2007, 68:37-46.
Knipe J: Targeting positive affect to clear the pain of unrequited love,
codependence, avoidance, and procrastination. EMDR solutions: Pathways
to healing New York: W W Norton & Co: R. Shapiro 2005, 189-212.
Miller R: The feeling-state theory of impulse-control disorders and the
impulse-control disorder protocol. Traumatology 2010, 16(3):2-10.
A26
Couples of significant others (COSO) in a joint effort to quit smoking
Aikaterini Tsoutsa*, Ioanna Nikoloutsou, Dimos Fotopoulos,
Constantinos Glynos, Spyridon Zakynthinos, Paraskevi Katsaounou
Pulmonary Department - ICU, Evangelismos Hospital, Athens, 10676,
Greece
Background: Motivational support is crucial for the success of smoking
cessation. Significant others are a proven source of that support [1,2]. As
far as we know social support has been used to achieve smoking
cessation higher rates, but only as support and not as a concurrent
attempt of a couple to quit smoking. We investigated whether the
inclusion of couples of significant others in a joint effort to quit smoking
in smoking cessation groups formed by a population based sample of
participants would increase their succession rate compared to the
participants that receive the same treatment alone.
Materials and methods: This was a randomized population-based
intervention study at the smoking cessation clinic of Evaggelismos hospital.
We monitored for people that are related in the initial screening stage.
Couples included life partners, family members or very close friends.
Smokers were in all motivational stages. All participants underwent the
same intervention with motivational and behavioural components in the
smoking cessation groups and received medical consultation and
pharmacotherapy (Varenicline). We compared so far the smoking cessation
rates of 25 “couples” and 50 randomized smokers that followed our
smoking cessation program.
Results: We found that participants that joint the COSO quit smoking in
a higher rate (58%) than of smokers (38%). Within the dyad the person
more motivated to quit smoking was usually the first to quit. Among
couples that quit smoking, men were more successful (63%) than
women (49%).
Conclusions: We conclude that higher smoking cessation rates were
obtained in COSO joining our smoking cessation program.
Acknowledgements: The research was sponsored by Evaggelismos
Hospital
References
1. Stice E, Ragan J, Randall P: Prospective relations between social support
and depression: differential direction of effects for parent and peer
support? J Abnorm Psychol 2004, 113:155-9.
2. Christakis NA, Fowler JH: The collective dynamics of smoking in a large
social network. N Eng J Med 2008, 358:2249-58.
A27
Psychiatric nurses’ knowledge and practices towards patients’ tobaccorelated habits in mental health hospitals in Greece
Evmorfia Koukia, Theodore Stathopoulos*
Psychiatric Nursing, Faculty of Nursing, University of Athens, Athens, 157-73,
Greece
Background: The aim of this study was to identify (a) nurses’ knowledge
towards patients’ smoking habits (b) nurses’ beliefs towards psychiatric
patients’ smoking practices and (c) nurses’ attitudes and practices.
Materials and methods: A questionnaire based study was contacted
among psychiatric nurses working on two major psychiatric hospitals. The
total sample consisted of 125 psychiatric nurses (4-year education in a
faculty of nursing of Technological Educational Institute) which represents
the 48% of licensed nurses working full-time.
Results: Various practices were noted among nurses concerning the
assessment of patients’ smoking history, passive smoking, smoking
habits and cessation plans. The majority of nurses (56.0% yes, 28.0%
sometimes) noted that psychiatric patient should be handled
differently. They stated that smoking cessation may exacerbate
psychiatric symptoms (38.0% yes, 62.0% sometimes) and may lead to
an illness relapse (46.0% yes, 44.0% sometimes). Nurses had some
knowledge about the health effects of smoking and they feel
responsible to help patient quit smoking.
Conclusions: To our knowledge this is the first attempt to describe
tobacco-related knowledge and practices among psychiatric nurses in
Greece. The findings indicated that half of psychiatric nurses smoke in their
work environment and are against the application of the anti-smoking law
in psychiatric hospitals. They believe that psychiatric patients should be
handled different from other patients even though they are aware of the
dangers of smoking.
A28
Design and implementation of questionnaires to assess chronic
exposure to secondhand smoke in children and adults
Mary Misailidi1*, Christos I Papakonstantinou1, Manolis N Tzatzarakis2,
Mathaios P Kavvalakis2, Yiannis Koutedakis3, Aristidis M Tsatsakis2,
Andreas D Flouris1
1
FAME Laboratory, Institute of Research and Technology Thessaly, Centre for
Research and Technology Hellas, Trikala, 42100, Greece; 2Centre of
Toxicology Science and Research, School of Medicine, University of Crete,
Heraklion, 71003, Greece; 3Department of Exercise Sciences, University of
Thessaly, Trikala, 42100, Greece
Background: Despite a multitude of anti-smoking campaigns being
active worldwide, the number of smokers is currently larger than at any
other time in human history. An essential first step towards minimizing
the health effects of secondhand smoke (SHS) is to accurately assess the
exposure level of individuals. The objectives of this study were to: (i) to
develop questionnaires that can identify never-smoking children and
adults experiencing increased exposure to secondhand smoke (SHS+),
(ii) to determine their validity against hair nicotine, and (iii) assess their
reliability.
Materials and methods: A sample of 191 children (85 males; 106 females;
7-18 years) and 95 adult (23 males; 72 females; 18-62 years) never-smokers
consented to hair nicotine analysis and answered a large number of
questions pertaining to all relevant sources of SHS. A randomly-selected
30% answered the questions again after 20-30 days.
Results: Prevalence of SHS+ in children and adults was 0.52±0.07 and
0.67±0.10, respectively (p<0.05). The Smoke Scale for Children (SS-C)
and the Smoke Scale for Adults (SS-A) were developed via factor
analysis and included nine questions each. Positivity criteria for
SS-C and SS-A via receiver operating characteristics (ROC) curve
analysis were identified at >16.5 and >16, respectively. Significant
Kappa agreement (p<0.05) was confirmed when comparing the SS-C
and SS-A to hair nicotine concentration. Reliability analyses
demonstrated that the SS-C and SS-A scores obtained on two different
days are highly correlated (p<0.001) and not significantly different
(p>0.05). Area under the curve and McNemar’s Chi-square showed no
pair-wise differences in sensitivity and specificity at the cutoff point
between the two different days for SS-C and SS-A (p>0.05).
Conclusions: We conclude that the SS-C and the SS-A represent valid,
reliable, practical, and inexpensive instruments to identify children and
adult never-smokers exposed to increased SHS.
A29
Fight against tobacco in Japan, before and after FCTC
Kazunari Satomura
Department of Public Health, Faculty of Medicine, Kyoto University, Kyoto,
606-8501 Japan
Page 11 of 14
Background: In 1965 smoking rate of male in Japan was 82.3% and
that of female was 15.7%. In 2005 when the FCTC was enacted,
smoking rate of male was 39.3% and that of female was 11.3%. In 2013
smoking rate of male is 32.2% and that of female is 10.5%. It seems
that several measures against smoking for the FCTC accelerate to
reduce the smoking rates. To find effective measures for decrease
smoking prevalence, anti-tobacco measures before and after the FCTC
are checked.
Results: (Before the FCTC): From 1898 to 1985, tobacco was under
monopoly. In that period, Act of Prohibiting Minors from Smoking is a
law worthy of mention. It was enacted in 1900 and revised several
times, but even now smoking of minors is illegal. This law has some
effect on reducing minors’ smoking, but minors who want to act like
adults become to smoke. Since ‘60s negative health effects of smoking
become to be known. In 1967, volumes of tar and nicotine in cigarettes
are printed on the package. Also warning: “Please be careful about
smoking too much “becomes to be printed on the package in 1972.
Since ‘70s, anti-smoking activities become popular. Some smokers
become aware of negative health effects of smoking and changed their
cigarettes named “light” or “mild”. The policies at that period were
”reducing smoking”, “separating smoking place” and “stopping
smoking”. Diffusing negative health effect of smoking reduces smoking
prevalence gradually.
(After the FCTC): TASPO which is a kind of ID card was introduced to
prevent minors from buying tobacco by vending machine in 2008.
Number of tobacco vending machines was decreased by it. Warning
messages become to be printed on the packages. They are scientific but
give small impact for smokers. The prices of cigarettes are raised. The
policies are changed to “separating smoking place”, “stopping smoking”,”
preventing minors from becoming smokers”. Smoking is recognized as
a disease and the medical fee for quitting smoking are paid by the
medical insurance.
Conclusions: These measures are insufficient. A large proportion of
people wants to become healthy and hates passive smoking. This trend
makes to reduce smoking places and smokers.
A30
Short term use of an e-cig: influence on clinical symptoms, vital signs
and eCO levels
Stamatoula Tsikrika*, Sophia Vakali, Sophia Antiopi Gennimata,
Anastasios Palamidas, Georgios Kaltsakas, Nikolaos Koulouris, Chritina Gratziou
Research unit for Tobacco Control, 1st Respiratory Department, University of
Athens, Medical School, Sotiria Hospital, Athens, 11527, Greece
Background: The risks of electronic cigarette are a subject of uncertainty.
The study was designed to assess the acute effect of smoking an
e-cigarette on vital signs, clinical symptoms and exhaled markers.
Materials and methods: Sixty two participants (32 men) with a mean age
of 45.43 years have been recruited. Sixteen smokers were suffered by
COPD, 12 smokers by asthma, 24 smokers had no overt airways disease. All
were current smokers with a long smoking history. A group of 10 nonsmokers was also included. The same brand of e-cig was used for 10 min
inhaled 11mg. Clinical symptoms, vital signs, - heart rate, oxygen saturation
(SpO2) and exhaled CO, was assessed pre and post the e-cig use.
Results: Cough and sore throat were presented in both groups, of nonsmokers and smokers following the e-cig smoking. Sore throat and cough
were reported by 90% of asthmatics and 63% of COPD. A significant
increase in heart rate (p<0.05) with palpitations was also noted with a
decrease in SpO2 mainly smokers (p<0.05). An interesting finding was the
significant increase in exhaled CO in the group of non-smokers (p<0.05).
Smoking an e-cig was acceptable and gave a feeling of pleasure in a low
number of participants (18 % of smokers, 27 % of smokers with asthma and
43% in smokers with COPD). There were also a 12% of non smokers who
have easily accepted its use.
Conclusions: Our study shows that even a single use of an e-cigarette
increased heart rate and symptoms like cough and sore throat. Claims that
electronic cigarettes can help smokers quit need to be backed up by
clinical studies and toxicity analyses and operate within the proper
regulatory framework.
A31
Combined effect of cigarette smoking and non-ferrous metal exposure
in the development of cardiovascular disease in industry workers: a
case-control study
Eniko Viragh1*, Karoly Viragh2, Claudia Munteanu3
1
University of Medicine and Pharmacy, Targu Mures, 540139, Romania; 2Olive
View UCLA Medical Center, Sylmar, Los Angeles, California, 91342, USA;
3
Authority of Public Health, Sibiu, 550012, Romania
Background: The purpose of the study was (1) to determine the
prevalence of smoking and cardiovascular disease in workers in nonferrous metallurgy, and (2) to evaluate the effect of cigarette smoking in
the development of cardiovascular disease in exposed workers.
Materials and methods: A retrospective case-control study was
performed. Industry workers from a nonferrous plant and controls were
monitored for an 8-year period. During this period, all workers received
regular clinical examinations, which included evaluation for smoking
status, occupational exposure to noxious non-ferrous metals (lead,Pb;
cadmium,Cd), and cardiovascular disease (hypertension, coronary artery
disease, peripheral vascular disease) using an epidemiological
questionnaire . Four representative groups were selected: Group (1)
included all workers with both smoking and exposure to noxious nonferrous metals. Group (2) included workers with smoking but without
noxious metal exposure. Group (3) included workers without smoking but
with exposure to noxious metals. Group (4) included workers without
smoking and without exposure to noxious metals. Groups (2) and (4)
were selected in such a way to match Groups (1) and (3) by age, gender,
work history, and lifestyle. The prevalence of smoking and cardiovascular
disease was determined in each group. Linear regression analysis was
used to assess the correlation between the levels of exposure and
biomarkers of exposures, as well as between the amount of smoking and
the burden of cardiovascular disease.
Results: During the studied period, noxious non-ferrous metal (Pb and Cd)
levels in the air of all workplaces were persistently high (Pb=0.9-13.3mg/m3;
Cd=0.3-1.3mg/m3). Clinical examination identified the classic symptoms of
chronic occupational intoxication with Pb and Cd. There was a relatively
high prevalence of smoking in each group. The prevalence of cardiovascular
disease was significantly higher in smokers and exposed workers. Linear
regression analysis identified a strong positive relationship between the
levels of exposure and biomarkers of exposure(r=0.69), between the amount
of smoking and burden of cardiovascular disorders (r=0.65).
Conclusions: There is high prevalence of smoking and cardiovascular
disease in industry workers. Cigarette smoking is an important risk factor for
cardiovascular disease and acts in combination with noxious non-ferrous
metals in exposed industry workers. Cigarette smoking may act as a
confounder in the assessment of the severity of occupational disease related
to noxious metal exposure in industry workers. The goal for all facilities and
workers is to minimize smoking and occupational exposure to noxious
agents.
A32
Chronic bronchitis in oil industry workers exposed to hydrocarbons:
role of cigarette smoking and gender differences
Eniko Viragh1*, Karoly Viragh2, Horia Suciu3
1
University of Medicine and Pharmacy, Targu Mures, 540139, Romania; 2Olive
View UCLA Medical Center, Sylmar, Los Angeles, California, 91342, USA;
3
Factory Medical Office, Suplacu de Barcau, 417536, Romania
Background: The purpose of the study was (1) to determine the
prevalence of smoking and chronic bronchitis in oil industry workers
exposed to hydrocarbons, and (2) to evaluate the effect of cigarette
smoking and gender differences in the development of chronic
bronchitis.
Materials and methods: A retrospective case-control study was
performed. Industry workers from an oil refinery were monitored for a 6yrs
period. The air levels of aliphatic and aromatic hydrocarbons were
monitored. During this period, all workers received regular clinical
Page 12 of 14
examinations, which included evaluation for smoking status, occupational
exposure to hydrocarbons (aliphatic and aromatic), and the presence and
severity of chronic bronchitis. The workers were divided into two groups of
approximately 100 patients each: Group (1) males exposed to hydrocarbons;
and Group (2) females exposed to hydrocarbons. Appropriately-matched
control groups were also selected from non-exposed workers, who matched
in age, gender, work history and lifestyle. The prevalence of smoking and
chronic bronchitis was determined in each group. Linear regression analysis
was used to assess the correlation between exposure to hydrocarbons and
effects (chronic bronchitis), as well as smoking, and severity of chronic
bronchitis.
Results: During the studied period, hydrocarbon levels in the air of all
workplaces were persistently high: aliphatic hydrocarbon levels were
1800mg/m3 (maximum allowable concentration, MAC = 1000mg/m3) and
aromatic hydrocarbon levels were 341.5ng/m3 (MAC=150ng/m3, marker:
3,4-benzo[a]pyrene). The prevalence of chronic bronchitis in hydrocarbonexposed females was 16.2%, higher than in exposed males 11.3%.
Smokers in each group had significantly higher rates of chronic bronchitis
than non-smokers. Linear regression analysis showed strong correlation
between exposure and chronic bronchitis: males (r=0.61) and females
(r=0.72).
Conclusions: There is high prevalence of smoking and respiratory disease
in exposed oil industry workers. Cigarette smoking is an important risk
factor for respiratory disease and acts in combination with hydrocarbons
in exposed industry workers. Females had more severe disease than
males. Cigarette smoking may act as a confounder in the assessment of
the severity of occupational disease related to hydrocarbon exposure in
industry workers. The goal for all facilities and workers is to minimize
smoking and occupational exposure to noxious agents.
A33
Quality of life among Greek smokers and nonsmokers. A study in local
community workers in Athens suburbia
Ioannis Roxanis1*, Sotiria Makaroni2, Maria Ginieri-Coccossis1,
Aggeliki Triantafyllou3, Maria Typaldou1
1
First Department of Psychiatry, Eginition Hospital, Athens University Medical
School, Athens, 11528, Greece; 2Center for the Prevention of Addictions and
Psychosocial Health Promotion “PRONOI”, Athens, 14500, Greece;
3
Department of Biological Chemistry, Athens University School of Medicine,
Athens, 10679, Greece
Background: Smoking is a predictor of quality of life and smoking habits
affect in different ways the quality of life between men and women. The
aim of this study is the assessment of quality of life of a working
population including smokers and non-smokers.
Materials and methods: The WHOQOL-BREF has been used in a random
sample of 144 municipal servants in a cross-sectional study.
Results: 46% of the study population were smokers. Independent
samples t-test revealed no significant difference between how smokers
and nonsmokers reported the main domains of their quality of life.
However, smoking had significant impact on two specific parameters.
Smokers recorded significant lower scores (3.62) than nonsmokers (3.86)
in satisfaction from overall health, (p=0.04). Furthermore, smokers had
statistically significant lower scores (3.30) in satisfaction from sleep than
nonsmokers (3.68), (p=0.02). There was no significant difference between
men and women smokers’ scores in main domains of quality of life, but
for particular items concerned satisfaction from overall health (p=0.04)
and difficulties from physical pain (p=0.00). Women smokers reported
lower scores in both items than male smokers. Multiple regression
analysis revealed that satisfaction from overall health had significant
correlation (p=0.02) only with smoking and no other variables from those
which have been examined.
Conclusions: Smoking seems to affect quality of life as far as satisfaction
from health is concerned. Further research, in bigger samples of working
population may reveal correlations between smoking and more aspects
of everyday life and more differences between male and female smokers.
Acknowledgements: Center for the Prevention of Addictions and
Psychosocial Health Promotion “PRONOI”, Municipality of Kifissia, OKANA
(Organization against drugs).
A34
Acute effect of an e-cigarette with and without nicotine on lung
function
Anastasios Palamidas*, Sophia Antiopi Gennimata, Georgios Kaltsakas,
Stamatoula Tsikrika, Sophia Vakali, Christina Gratziou, Nikolaos Koulouris
Background: E-cig is an electrical device that vaporizes propylene or
polyethylene glycol-based liquid solution into an aerosol mist containing
different concentration of nicotine. Our preliminary study showed an
increase in Raw, a concomitant decrease in sGaw and an increase in slope
of phase III in a limited number of subjects immediately after smoking
a single e–cig containing nicotine.
Materials and methods: We extended our protocol in a larger group of
never smokers and in smokers. We implemented the same protocol with
a nicotine free e-cig in a group of never smokers. We studied 60 subjects
before and after smoking an e-cig containing 11mg nicotine (Group A).
Group A: 9 never smokers and 51 smokers (24 had no overt airways
disease, 11 asthma, 16 COPD). Another group of 10 never smokers used a
nicotine free e-cig (Group B). Lung function assessed pre and post e-cig
use including lung volumes, airway resistance (Raw), specific airway
conductance (sGaw) and the slope of phase III. The same brand of e-cig
used in both groups, with 11 and 0mg of nicotine.
Results: Group A: a significant increase in Raw was shown in smokers and
in never smokers (0.284±0.13-0.308±0.14; p= 0.033, 0.246±0.07-0.292±0.05;
p=0.006) with significant decrease in sGaw (1.197±0.50-1.060±0.42; p= 0.009,
1.313±0.22-1.109±0.18; p= 0.043). Increased slope in phase III was shown
only in asthmatic patients (p=0.008). Group B: increase in Raw (0.247±0.030.333±0.08; p=0.005) and a decrease in sGaw (1.213±0.29-0.944±0.18;
p=0.009) noted.
Conclusions: The present study supports our preliminary results
showing increased Raw and a concomitant decrease in sGaw. These
changes might be due to the vaporizing liquid but not to the inhaled
nicotine per se.
A35
E- Cigarette acute effect on symptoms and airway inflammation:
comparison of nicotine with a non-nicotine cigarette
Sophia Vakali*, Stamatoula Tsikrika, Sophia Antiopi Gennimata,
Georgios Kaltsakas, Anastasios Palamidas, Nikolaos Koulouris,
Christina Gratziou
Background: Despite the increasing advertising of e-cigarettes as safe
smoking tool, there is much debate regarding its safety. This study was
undertaken to assess the effect of a single e-cigarette use on clinical
symptoms, vital signs and airway inflammatory markers after inhaling
either 0mg or 11mg of nicotine.
Materials and methods: We studied 64 subjects (aged 22-65 years,
34 men) divided in 2 groups. Group A: 12 never smokers and 29 healthy
smokers smoked for 10 min a single e-cigarette containing 11mg of
nicotine and Group B: 14 never smokers and 9 healthy smokers smoked
a single e-cigarette containing 0mg of nicotine. The same brand of e-cig
was used in both groups with similar liquid `ingredients but with two
different nicotine concentrations. Vital signs, symptoms questionnaire,
Oxygen Saturation (SpO2) ,heart rate(HR)] and indices of airway
inflammation(exhaled NO, and airways temperature) were assessed pre
and post smoking.
Results: All subjects reported symptoms immediately after smoking, but the
respiratory (sore throat, cough) and the cardiovascular symptoms
(palpitations) were reported more often in Group A compared with Group B,
whereas dizziness, was more frequently reported from non smokers of
Group B. An increase in HR was noted in all subjects of Group A, findings
that were not recorded in group B. A decrease in FeNO was detected in
smokers and non-smokers of Group B, with an increase in airways
temperature (p=0.051) in smokers of Group A.
Page 13 of 14
Conclusions: Increased heart rate, palpitations and a decrease in SpO2 ,
are related to the use of a nicotine containing e-cig but airways symptoms
(sore throat, cough) and inflammatory markers are independent of
nicotine use.
A36
Intervention program to modify the smoking habit in employee
group of Athens’ social welfare organization using motivational
interviewing techniques and Trans theoretical Model of Behavior
Change
Eleftheria Kenanidou
Health Visitor, Athens, Greece
Background: Smoking is globally the most important risk factor for health
and a major factor of mortality. It is responsible for many diseases, such as
cardiovascular diseases, digestive system, musculoskeletal system,
respiratory system, coronary artery disease, vascular strokes, while
destroying the immune system and increases the risk of infections. The aim
of this study was to assess the effectiveness of the motivational interviewing
and Trans theoretical Model of Behavior Change related to the modification
of the smoking habit.
Materials and methods: The present study took place in Athens’ Social
Welfare Organization. The intervention program was held as part of a
boarder program, whose purpose was to amend behaviors that constitute
risk factors for health and related to the way of living and specifically
with the smoking habit. Four Questionnaires were used for this study.
One of these is a Health Questionnaire with questions about nutrition,
physical activity, stress levels and behaviors related to smoking. Also, the
Change Questionnaire about smoking, the Socrates 8D Questionnaire and
finally a process evaluation Questionnaire. Ten (10) people were placed
randomly in the intervention and control groups. People in intervention
group participated in six (6) sessions lasting 35 minutes using the
motivational interviewing techniques, while those in the control group
received one meeting session lasting 25 minutes with information about
the benefits of quitting smoking and the pharmacological treatment
options.
Results: While initially the changes in relation to the smoking habits
ranged from mild to effective, in the intervention group all people after
the end of the intervention program reported the desire of stop (60%)
and reduce (40%) smoking. In both groups there is an upward trend in
the intensity of thoughts, expectations and feelings associated with
smoking. None of those two groups mentioned abstinence and quitting
smoking.
Conclusions: Also, the population sample is not representative of the
general population and the results couldn’t be generalized. Finally, the
analysis of the results showed the positive attitude of all people
in the implementation of such programs.
A37
Tobacco advertising in Points-of-Sale around urban schools in
Romania
Vlad Dediu1, Lambros Lazuras2*, Constantine Vardavas3,4
1
Psychology Department, International Faculty of the University of
Sheffield, Thessaloniki, 54622, Greece; 2South East European Research
Center, SEERC, Thessaloniki, 54622, Greece; 3Clinic of Social and Family
Medicine, University of Crete, Heraklion, 71003, Greece; 4Center for Global
Tobacco Control, Harvard School of Public Health, Boston, Massachusetts,
02115, USA
Background: Price promotions in points of sale (POS) are risk factors for
tobacco use initiation and shape pro-smoking beliefs among adolescents
[1]. The aim of the present study was to assess the extent of tobacco
advertisements in POS located near schools in Romania.
Materials and methods: Tobacco industry advertising was measured in
POS (interior and exterior advertising) that were within close proximity
(< 300 m) to high schools [2], in the urban area of Bucharest, Romania.
A total of 72 POS were identified around 10 schools.
Results: On average there were 7 POS around each school, with one in
twelve POS directly visible from school gates. Advertising was more
common internally (77.8% of all POS) than externally, and price promotions
were more frequent indoors than outdoors. External tobacco ads were
recorded in 19.7% of POS. British American Tobacco and Altria Group, Inc.
(parent company of Philip Morris) were responsible for > 60% of external
price promotions. Out of the 12 brands recorded, the most widely
advertised were Kent, followed by Virginia, Philip Morris and Pall Mall,
accounting for 75.7% of the cases. Overall, 36.1% of tobacco advertising was
medium-to-high intensity.
Conclusion: The present study is the first one of its kind conducted in
Romania, assessing the geo-position of POS around schools. Internal
advertising was more common than external ads or price promotions, and
the Altria group was responsible for most of them. The present findings can
set the basis for future research into the effects of tobacco advertising
around schools on adolescents’ smoking behavior.
Page 14 of 14
References
1. Vardavas CI, Girvalaki C, Lazuras L, Triantafylli D, Lionis C, Connolly GN,
Behrakis P: Changes in tobacco industry advertising around high schools
in Greece following an outdoor advertising ban: a follow-up study.
Tobacco control 2013, 22(5):299-301.
2. Vardavas CI, Connolly GN, Kafatos AG: Geographical information systems
as a tool for monitoring tobacco industry advertising. Tobacco control
2009, 18(3):190-196.
Cite abstracts in this supplement using the relevant abstract
number, e.g.: Dediu et al.: Tobacco advertising in Points-of-Sale
around urban schools in Romania. Tobacco Induced Diseases 2014,
12(Suppl 1):A37

11th Annual Conference of the International Diseases (ISPTID)

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