Sex-Differences in Lung Cancer Cell-Types? An Epidemiologic Study in Ireland

Objective: This study assesses the epidemiological pattern of lung cancer cell-types in Ireland, with identification of any underlying gender variations. Methods: Lung cancer incidence data, including the major cell-types: squamous-cell-carcinoma (SCC), adenocarcinoma (AC), small-cell-lung-carcinoma (SCLC) and large-cell-carcinoma (LCC) were obtained from the national cancer registry (1994–2000), together with individual characteristics, such as age, gender, smoking status, and the year of diagnosis. Age-standardised incidence rates (ASIR), male-to-female (M: F) rate ratios (RR) of ASIR for SCC and AC, as well as RR of AC: SCC according to smoking status for both sexes, were estimated. Estimated-annual-percent-changes for each of the cell-types were calculated. Results: AC incidence in females is rising annually (8.5%, p=0.008) from 1994 to 2000, while SCC is declining (−5.4%, p=0.01) in males. M: F ratios of ASIR are consistently greater than ‘one’, but converging recently. RR of AC: SCC is also approaching ‘unity’ across both sexes, irrespective of the smoking status. Conclusions: An apparent increase in lung AC incidence in females was observed in Ireland that might indicate some local environmental risk factors, in addition to changing smoking habits. The study findings do not support the hypothesis that females in general are at higher risk for lung cancer development, but tobacco and histologic-specific susceptibility cannot be ruled out

Recent Lung Cancer Patterns in Younger Age-Cohorts in Ireland

Background: Smoking causes 85% of all lung cancers in males and 70% in females. Therefore, birth cohort analysis and annual-percent-changes (APC) in age-specific lung cancer mortality rates, particularly in the youngest age cohorts, can explain the beneficial impacts of both past and recent anti-smoking interventions. Methods: A long-term time-trend analysis (1958-2002) in lung cancer mortality rates focusing on the youngest age-cohorts (30-49 years of age) in particular was investigated in Ireland. The rates were standardised to the World Standard Population. Lung cancer mortality data were downloaded from the WHO Cancer Mortality Database to estimate APCs in death rates, using the Joinpoint regression (version 3.0) program. A simple age-cohort modelling (log-linear Poisson model) was also done, using SAS software. Results: The youngest birth cohorts (born after 1965) have almost one-fourth lower lung cancer risk relative to those born around the First World War. A more than 50% relative decline in death rates among those between 35 and 39 years of age was observed in both sexes in recent years. The youngest age-cohorts (30-39 years of age) in males also showed a significant decrease in death rates in 1998-2002 by more than 3% every five years from 1958-1962 onwards. However, death rate declines in females are slower. Conclusions: The youngest birth cohorts had the lowest lung cancer risk and also showed a significant decreasing lung cancer death rate in the most recent years. Such temporal patterns indicate the beneficial impacts of both recent and past tobacco control efforts in Ireland. However, the decline in younger female cohorts is slower. A comprehensive national tobacco control program enforced on evidence-based policies elsewhere can further accelerate a decline in death rates, especially among the younger generations

Smoking behaviour, involuntary smoking, attitudes towards smoke-free legislations, and tobacco control activities in the European Union

The six most important cost-effective policies on tobacco control can be measured by the Tobacco Control Scale (TCS). The objective of our study was to describe the correlation between the TCS and smoking prevalence, self-reported exposure to secondhand smoke (SHS) and attitudes towards smoking restrictions in the 27 countries of the European Union (EU27)

A Qualitative Study of E-cigarette Use Among Young People in Ireland: Incentives, Disincentives and Putative Cessation.

Background Smoking prevalence in Ireland is falling in all age groups, but e-cigarette use is rising among young people. This qualitative study explores young people’s accounts of e-cigarette use in Ireland. Methods Semi-structured individual (22) and focus group (8) interviews were conducted with 62 young people aged 18–22 years, recruited from a higher-education institution and youth organisations working with early school-leavers across Dublin. All were smokers or exsmokers; 41 had tried e-cigarettes, 11 continued as dual users. We identified themes using thematic data analysis. Results Three broad themes were identified: incentivising features, disincentivising features, and ambivalent and unsuccessful cessation, named putative smoking cessation. Incentivising features included price, pleasing taste/ flavours, and the possibility of indoor use. Disincentivising features related to adverse health effects (pain, discomfort, sore throat, coughing, headache) and unpleasant physical effects (bad taste, problems resulting from device faults). Other disincentives were over-consumption arising from inability to control intake, greater addictiveness , product taste, and device faults. Putative cessation refers to the conflict between participants’ expected use of e-cigarettes as a smoking cessation/reduction aid and their observed reality of e-cigarettes’ failure in this regard, with reported outcomes including: failure to quit or reduce; continued or resumed cigarette and/or roll-your-own smoking; dual use of e-cigarettes and other tobacco products; and inability to quit ecigarettes. Conclusions Participants were sceptical about e-cigarettes’ purported relative healthihiness , concerned about addictiveness and potential long-term health consequences, and critically aware of advertising and industry strategies. E-cigarettes were viewed as being less denormalised, in part because they could be used in indoor spaces where smoking is banned in Ireland. Although price, taste, and perceived renormalisation were important motivators for young people’s use of e-cigarettes, they wanted to quit smoking. The regulation of e-cigarettes through age restriction of access, licensing of outlets, pricing, point of sale and advertising restrictions as well as through the banning of indoor use should be considered by legislators and tobacco control policymakers

Sociodemographic, personal, peer, and familial predictors of e-cigarette ever use in ESPAD Ireland: A forward stepwise logistic regression model

Introduction:E-cigarette ever use has risen significantly in recent years in Ireland, similar to trends elsewhere in Europe, the United States, and Asia-Pacific region. Results from ESPAD Ireland (European School Survey Project on Alcohol and other Drugs) show teenage e-cigarette ever use increased from 18% (2015) to 37% (2019). Given this increase, our aim is to profile e-cigarette ever users and never users in this age group; to examine sociodemographic, personal, peer, and familial factors associated with e-cigarette ever use; and to suggest appropriate measures to reduce use.Methods:A nationally representative stratified random sample of 50 ESPAD schools was surveyed in 2019, with 3495 students aged 15–17 years. Bivariate and multivariable logistic regression analyses were performed using Stata version 16.Results:E-cigarette ever use was significantly associated with ever smoking (AOR=4.15; 95% CI: 1.29–13.41), ever cannabis use (AOR=2.21; 95% CI: 1.11–4.41) and ever inhalants use (AOR=2.51; 95% CI: 1.07–5.88). Children of university-educated mothers had significantly higher odds of e-cigarette ever use (AOR=3.46; 95% CI: 1.40–8.54). Associated with reduced AORs were reading books for enjoyment (AOR=0.32; 95% CI: 0.16–0.64), living in households where smoking was regulated (AOR=0.53; 95% CI: 0.30–0.94), and perceiving moderate risk in trying e-cigarettes once or twice (AOR=0.20; 95% CI: 0.07–0.67).Conclusions:E-cigarette ever use is part of a pattern of teenage polysubstance use including cigarette smoking, providing some support for the common liability theory. Regulation of smoking in the home, reading for enjoyment, and perceiving risk from e-cigarette use are associated with decreased likelihood of ever use, and higher parental education with increased likelihood. Thus, health education emphasizing the role of parents and risks of e-cigarette use is indicated to reduce the rise in e-cigarette ever use in teenagers

It’s Not All About Price: Factors associated with roll-your-own tobacco use among young people - a qualitative study

Background: Smoking prevalence in Ireland is falling in all age groups, but the prevalence of roll-your-own (RYO) tobacco use is rising among young people. This qualitative study aims to explore and understand the factors associated with young people\u27s use of RYO products. Methods: Semi-structured individual and focus group interviews were conducted with young people aged 16-22 years. Participants were recruited from a higher education institution and youth organisations working with early school leavers across Dublin. In total, there were 62 participants in the study, consisting of 22 individual interviews and eight focus group interviews with 40 participants. Categoric and thematic data analysis was used to generate the findings. Results: We identified two broad themes, incentivising and disincentivising factors. The lower cost of RYO products compared to pre-manufactured cigarettes was the most important incentive for users. However, other product characteristics, such as the artisanal factors associated with RYO products were also found. Social and environmental influences were apparent, in which certain groups and environments facilitated and normalised RYO practices. Amenities and facilities often provided smokers with normalised spaces which could be dedicated to the enactment of rolling practices and to the creation and maintenance of social bonds with other users. Disincentives included negative features related to the product itself, adverse health effects, and the effects of tobacco denormalisation. Conclusions: While the lower cost of RYO products is very important for young smokers, other product characteristics and influences also incentivise and disincentivise use. A more comprehensive understanding of the multi-dimensional appeal of these products will assist policymakers to target strategies to reduce the attractiveness to young smokers of these products

E-cigarettes and smoking in Irish teens: a logistic regression analysis of current (past 30-day) use of e-cigarettes

Aim Electronic cigarette (e-cigarette) use among Irish teenagers has risen significantly. In 2019, prevalence of current use (last 30 days) among 15–17-year-olds was 17.3%. We examine social determinants of adolescent e-cigarette current use. Subject and methods A stratified random sample of 50 schools in Ireland was surveyed in 2019, part of the European School Survey Project on Alcohol and other Drugs (ESPAD), with 3495 students aged 15, 16, and 17. Bivariate and multivariable logistic regression [providing adjusted odds ratios (AORs)] analyses were performed using Stata version 16. Results Current e-cigarette users were more likely to be male (AOR = 0.55, 95% CI:0.32–0.96, p \u3c .01), younger (AOR = 0.34, 95% CI: 0.17–0.67, p = \u3c .05), to participate in sport (AOR = 2.21, 95% CI: 1.05–4.65, p \u3c .05), to have higher-educated parents (maternal higher education: AOR = 27.54, 95% CI: 1.50–505.77, p = \u3c .05, paternal higher education: AOR = 2.44, 95% CI: 1.00–5.91, p \u3c .05), and less likely to consider their families better off (AOR = 0.29, 95% CI: 0.13–0.65, p \u3c .01), or to report familial support (AOR = 0.78, 95% CI: 0.64–0.95, p \u3c .05). They were more likely to be cigarette smokers (AOR = 7.22, 95% CI: 3.97–13.12, p \u3c .001), to report problem cannabis use (AOR = 3.12, 95% CI: 1.40–6.93, p \u3c .01), to be ‘binge’ drinkers (AOR = 1.81, 95% CI : 1.00–3.32, p = .054), and to have friends who get drunk (AOR = 5.30, 95% CI: 1.34–20.86, p \u3c .05). Conclusion Boys, smokers, binge drinkers, problem cannabis users, and sport-playing teenagers from higher-educated families, are at particular risk. As the number of young people using e-cigarettes continues to rise, including teenagers who have never smoked, improved regulation of e-cigarettes, similar to other tobacco-related products, is needed urgently to prevent this worrying new trend of initiation into nicotine addiction

The associations of parental smoking, quitting and habitus with teenager e-cigarette, smoking, alcohol and other drug use in GUI Cohort ’98

We analyse parental smoking and cessation (quitting) associations with teenager e-cigarette, alcohol, tobacco smoking and other drug use, and explore parental smoking as a mechanism for social reproduction. We use data from Waves 1–3 of Growing Up in Ireland (Cohort ’98). Our analytic sample consisted of n = 6,039 participants reporting in all 3 Waves. Data were collected in Waves 1 and 2 when the children were 9 and 13 years old and in Wave 3 at age 17/18 years. Generalized Estimating Equations (GEE) models were used to analyse teenage substance use at Wave 3. Parental smoking was associated with significantly increased risk of all teenage substance use, adjusted odds ratios were aOR2.13 (ever e-cigarette use); aOR1.92 (ever alcohol use); aOR1.88 (current alcohol use); aOR1.90 (ever use of other drugs); aOR2.10 (ever-smoking); and aOR1.91 (current smoking). Primary caregiver smoking cessation (quitting) was associated with a lower risk for teenager current smoking aOR0.62, ever e-cigarette use aOR 0.65 and other drug use aOR 0.57. Primary caregiver smoking behaviour had greater associations than secondary, and age13 exposure more than age 9. Habitus seems to play a role and wealth was protective for teenage smoking. The findings suggest that prevention interventions should target both caregivers and their children