Introduction: Compared to the general population, cigarette smokers report poorer sleep quality. Poor sleep quality in cigarette smokers is associated with greater nicotine dependence. While exercise is known to improve sleep quality in the general population, less is known about how exercise effects sleep in those who smoke. The goal of this study was to explore the relationships between exercise, sleep, and smoking in cigarette smokers. Methods: Data on sleep quality (Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI)), smoking-related outcomes (e.g., cigarettes/day, Fagerstrom Test for Nicotine Dependence, Minnesota Nicotine and Withdrawal Scale, and Questionnaire of Smoking Urges) and exercise (Fitbit activity measures) were collected for 32 participants (63% female, mean age 30.3 ± 1.0 years) participating in a 12-week clinical research study. Analyses included simple linear regression models. Results: Overall, participants reported poor sleep quality at baseline (PSQI>5). Poorer sleep quality at baseline was associated with increased withdrawal (β=1.63±0.53, p=0.0043), craving (β=0.51±0.43, p=0.2471), and total smoking urges (β=1.10±0.41, p=0.0118). During follow-up (i.e., from baseline to week 12), a daily increase in exercise was associated with improved sleep quality over the same time period (PSQI: β=-0.82± 0.35, p=0.0379). Conclusion: Our data suggest that better sleep quality may be associated with lower levels of withdrawal, craving, and smoking urges. Further, exercise may be associated with better sleep quality in cigarette smokers. Future work should explore how increasing exercise and improving sleep quality could inform future smoking cessation interventions.
The number of rural hospitals offering labor and delivery services has been declining across the United States for decades. As a part of this trend, labor and delivery services at Cook County North Shore Hospital in Grand Marais, Minnesota were discontinued in July of 2015. The closure necessitates that patients now travel to Duluth, 110 miles away, for hospital-based delivery services. Partnership between Duluth’s regional campus medical school and this rural community has grown to incorporate researching the effects of this closure on the Cook Country region including the community of Grand Marais. A prior study undertaken evaluated patients’ perspectives on this loss of local obstetrical services. This study was undertaken to better characterize the utilization and clinical outcomes of obstetrical care for patients before and after local labor and delivery services were discontinued. Retrospective chart review was done comparing measures before and after delivery services discontinued locally. Although not statistically significant, patterns since closure include an increased percentage of inductions, home births, and cesarean deliveries for women in Cook County.
Introduction The objective of this clinical trial was to compare the effects of e-cigarettes with and without nicotine on patterns of combustible cigarette use and biomarkers of exposure to tobacco toxicants among African American smokers. Methods African American smokers (n = 234) were enrolled in a 12-week, single blind, randomized controlled trial and assigned to ad lib use of nicotine e-cigarettes with or without menthol (2.4% nicotine [equivalent to combustible cigarettes], n = 118), or no-nicotine e-cigarettes (n = 116) for 6 weeks. Surveys were administered at baseline, 2, 6, and 12 weeks, and urinary biomarkers 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and total nicotine equivalents (TNE) were assessed at baseline and 6 weeks. Results Participants smoked an average of 11.4 cigarettes per day (CPD) and 88% used menthol cigarettes at baseline. At Week 6, the nicotine group reported using e-cigarettes 9.1 times per day compared to 11.4 times in the no-nicotine group (p = 0.42). Combustible cigarette smoking decreased 3.0 CPD in the nicotine group compared to 2.7 CPD in the no-nicotine group (p = 0.74). Neither TNE nor NNAL changed significantly between baseline and Week 6. There were no differences in nicotine withdrawal symptoms between treatment groups. Smoking reduction persisted in both groups at Week 12. Conclusions Contrary to our hypotheses, nicotine e-cigarettes did not significantly reduce the use of combustible cigarettes compared to no-nicotine e-cigarettes in this cohort of African American smokers. Findings suggest e-cigarettes are modestly associated with the decreased use of combustible cigarettes among non-treatment seeking smokers, regardless of nicotine content, but without a reduction in tobacco toxicants. Implications Although e-cigarettes have the potential to reduce harm if substituted for combusted cigarettes (or if they promoted cessation) because of lower levels of tobacco toxicants, this study suggests ad lib use of e-cigarettes among African American smokers, with or without nicotine, results in modest smoking reduction but does not change toxicant exposure in a cohort where smoking cessation or reduction is not the goal. These data suggest that testing future harm reduction interventions using e-cigarettes should include more specific behavioral change coaching, including substituting for or completely stopping combusted cigarettes. Clinical Trial Registration ClinicalTrials.gov – NCT03084315
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