PDF(Pubmed)
Abstract：
BACKGROUND: Quitting smoking may lead to improvement in substance use, psychiatric symptoms, and pain, especially among high-risk populations who are more likely to experience comorbid conditions. However, causal inferences regarding smoking cessation and its subsequent benefits have been limited.
METHODS: We emulated a hypothetical open-label randomized control trial of smoking cessation using longitudinal observational data of HIV-positive and HIV-negative US veterans from 2003-2015 in the Veterans Aging Cohort Study. We followed individuals from the first time they self-reported current cigarette smoking (baseline). We categorized participants as quitters or non-quitters at the first follow-up visit (approximately 1 year after baseline). Using inverse probability weighting to adjust for confounding and selection bias, we estimated odds ratios for improvement of co-occurring conditions (unhealthy alcohol use, cannabis use, illicit opioid use, cocaine use, depressive symptoms, anxiety symptoms, and pain symptoms) at second follow-up (approximately 2 years after baseline) for those who quit smoking compared to those who did not, among individuals who had the condition at baseline.
RESULTS: Of 4,165 eligible individuals (i.e., current smokers at baseline), 419 reported no current smoking and 2,330 reported current smoking at the first follow-up. Adjusted odds ratios (95% confidence intervals) for associations between quitting smoking and improvement of each condition at second follow-up were: 2.10 (1.01, 4.35) for unhealthy alcohol use, 1.75 (1.00, 3.06) for cannabis use, 1.10 (0.58, 2.08) for illicit opioid use, and 2.25 (1.20, 4.24) for cocaine use, 0.78 (0.44, 1.38) for depressive symptoms, 0.93 (0.58, 1.49) for anxiety symptoms, and 1.31 (0.84, 2.06) for pain symptoms.
CONCLUSIONS: While a causal interpretation of our findings may not be warranted, we found evidence for decreased substance use among veterans who quit cigarette smoking but none for the resolution of psychiatric conditions or pain symptoms. Findings suggest the need for additional resources combined with smoking cessation to reduce psychiatric and pain symptoms for high-risk populations.
METHODS: We emulated a hypothetical open-label randomized control trial of smoking cessation using longitudinal observational data of HIV-positive and HIV-negative US veterans from 2003-2015 in the Veterans Aging Cohort Study. We followed individuals from the first time they self-reported current cigarette smoking (baseline). We categorized participants as quitters or non-quitters at the first follow-up visit (approximately 1 year after baseline). Using inverse probability weighting to adjust for confounding and selection bias, we estimated odds ratios for improvement of co-occurring conditions (unhealthy alcohol use, cannabis use, illicit opioid use, cocaine use, depressive symptoms, anxiety symptoms, and pain symptoms) at second follow-up (approximately 2 years after baseline) for those who quit smoking compared to those who did not, among individuals who had the condition at baseline.
RESULTS: Of 4,165 eligible individuals (i.e., current smokers at baseline), 419 reported no current smoking and 2,330 reported current smoking at the first follow-up. Adjusted odds ratios (95% confidence intervals) for associations between quitting smoking and improvement of each condition at second follow-up were: 2.10 (1.01, 4.35) for unhealthy alcohol use, 1.75 (1.00, 3.06) for cannabis use, 1.10 (0.58, 2.08) for illicit opioid use, and 2.25 (1.20, 4.24) for cocaine use, 0.78 (0.44, 1.38) for depressive symptoms, 0.93 (0.58, 1.49) for anxiety symptoms, and 1.31 (0.84, 2.06) for pain symptoms.
CONCLUSIONS: While a causal interpretation of our findings may not be warranted, we found evidence for decreased substance use among veterans who quit cigarette smoking but none for the resolution of psychiatric conditions or pain symptoms. Findings suggest the need for additional resources combined with smoking cessation to reduce psychiatric and pain symptoms for high-risk populations.
摘要：
背景：戒烟可能会导致物质使用的改善，精神症状,和痛苦，尤其是在更有可能经历合并症的高危人群中。然而,关于戒烟及其后续益处的因果推断是有限的.
方法：在退伍军人衰老队列研究中，我们使用2003-2015年HIV阳性和HIV阴性美国退伍军人的纵向观察数据，模拟了一项假设的戒烟开放标签随机对照试验。我们从第一次自我报告当前吸烟（基线）开始跟踪个体。我们在第一次随访时（基线后约1年）将参与者分为戒烟者或非戒烟者。使用逆概率加权来调整混杂和选择偏差，我们估计了改善共存条件的优势比(不健康的饮酒，使用大麻,非法使用阿片类药物,可卡因的使用,抑郁症状,焦虑症状,和疼痛症状）在第二次随访中（基线后约2年），与戒烟者相比，在基线时患有该疾病的个体中。
结果：4,165名符合条件的个人（即，当前基线吸烟者)，在第一次随访时，419报告目前没有吸烟，2,330报告目前吸烟。第二次随访时戒烟与每种情况改善之间的关联的调整后优势比（95％置信区间）为：不健康饮酒的2.10（1.01，4.35），1.75（1.00，3.06）用于大麻使用，1.10（0.58，2.08）用于非法使用阿片类药物，和2.25（1.20，4.24）用于可卡因的使用，0.78（0.44，1.38）抑郁症状，0.93（0.58，1.49）的焦虑症状，疼痛症状为1.31（0.84，2.06）。
结论：虽然我们的研究结果可能不需要因果解释，我们发现有证据表明戒烟退伍军人的药物使用减少,但没有证据表明精神病或疼痛症状得到缓解.研究结果表明，需要额外的资源与戒烟相结合，以减少高危人群的精神和疼痛症状。
方法：在退伍军人衰老队列研究中，我们使用2003-2015年HIV阳性和HIV阴性美国退伍军人的纵向观察数据，模拟了一项假设的戒烟开放标签随机对照试验。我们从第一次自我报告当前吸烟（基线）开始跟踪个体。我们在第一次随访时（基线后约1年）将参与者分为戒烟者或非戒烟者。使用逆概率加权来调整混杂和选择偏差，我们估计了改善共存条件的优势比(不健康的饮酒，使用大麻,非法使用阿片类药物,可卡因的使用,抑郁症状,焦虑症状,和疼痛症状）在第二次随访中（基线后约2年），与戒烟者相比，在基线时患有该疾病的个体中。
结果：4,165名符合条件的个人（即，当前基线吸烟者)，在第一次随访时，419报告目前没有吸烟，2,330报告目前吸烟。第二次随访时戒烟与每种情况改善之间的关联的调整后优势比（95％置信区间）为：不健康饮酒的2.10（1.01，4.35），1.75（1.00，3.06）用于大麻使用，1.10（0.58，2.08）用于非法使用阿片类药物，和2.25（1.20，4.24）用于可卡因的使用，0.78（0.44，1.38）抑郁症状，0.93（0.58，1.49）的焦虑症状，疼痛症状为1.31（0.84，2.06）。
结论：虽然我们的研究结果可能不需要因果解释，我们发现有证据表明戒烟退伍军人的药物使用减少,但没有证据表明精神病或疼痛症状得到缓解.研究结果表明，需要额外的资源与戒烟相结合，以减少高危人群的精神和疼痛症状。
