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Biomedical subjects

Gary A Giovino

Publications and source records attributed to Gary A Giovino.

At least 19 recordsLinked to original sources
PubMed2006

Lifetime cumulative exposure to secondhand smoke and risk of myocardial infarction in never smokers: results from the Western New York health study, 1995-2001.

BACKGROUND: Although many epidemiologic studies have investigated the association between exposure to secondhand smoke (SHS) and risk of coronary heart disease (CHD), few of these studies have assessed exposure measures from different sources over a lifetime. Therefore, we sought to test the association between lifetime cumulative exposure to SHS and risk of myocardial infarction (MI) (as an indication of CHD) among never smokers. METHODS: A population-based case-control study in which participants were 1541 never smokers (284 cases and 1257 controls) drawn from 1197 women and men with incident MI and 2850 healthy controls (aged 35-70 years) identified from 2 Western New York counties between 1995 and 2001. Study subjects were asked to report their exposure to SHS at home, at work, and in public settings from childhood to their present age. Exposure histories from each source were combined to form a cumulative lifetime exposure measure. Multiple logistic regression analysis estimated the association between SHS exposure and case status adjusted for age, sex, education, body mass index, race, drinking status, lifetime physical activity, hypertension, diabetes mellitus, and hypercholesterolemia. RESULTS: After adjustment for covariates, exposure to SHS was not significantly associated with an increased risk of MI. Compared with participants in the bottom tertile of SHS exposure, those in the top tertile had an odds ratio of 1.19 [95% confidence interval, 0.78-1.82] for MI. Virtually all subjects reported some exposure to SHS over their lifetime, but self-reported exposures declined over time, especially in the period closest to the interview. CONCLUSIONS: Exposure to SHS has declined sharply among nonsmokers in recent years. In the absence of high levels of recent exposure to SHS, cumulative lifetime exposure to SHS may not be as important a risk factor for MI as previously thought.

Adult↗
PubMed2006

Changes in nicotine intake and cigarette use over time in two nationally representative cross-sectional samples of smokers.

Population surveys have observed decreases in cigarette use over time among smokers. These decreases have probably been influenced by tobacco control measures implemented over the past several decades, but few data exist on whether smokers have also reduced their nicotine intake. The authors examined data from two cross-sectional National Health and Nutrition Examination Surveys (NHANES), conducted in 1988-1994 and 1999-2002. Laboratory, examination, and interview data from current smokers not reporting nicotine intake from other sources were examined. From NHANES III (1988-1994) to NHANES 1999-2002, the average number of cigarettes smoked per day (CPD) fell by nearly 15% (three cigarettes), while the mean serum cotinine level fell by 13% (30 ng/ml). Finer breakdowns of CPD data in each time period suggested that most of the change occurred in the lower (<10 CPD) and higher (>or=20 CPD) smoking categories. These data suggest that CPD may represent a proxy for exposure to nicotine and perhaps other tobacco smoke constituents on the population level, since the decline in serum cotinine levels observed among smokers closely paralleled the decline in self-reported CPD between 1988-1994 and 1999-2002. In addition, these data are inconsistent with the hypothesis that the remaining population of smokers is becoming more dependent on nicotine over time.

Adult↗
PubMed2006

Smoke-free laws and secondhand smoke exposure in US non-smoking adults, 1999-2002.

OBJECTIVES: To investigate the relationship between smoke-free law coverage and secondhand smoke (SHS) exposure in the United States non-smoking adult population. DESIGN: We used data from the 1999-2002 National Health and Nutrition Examination Survey, a cross-sectional survey designed to monitor the health and nutritional status of the US population. Serum cotinine levels were available for 5866 non-smoking adults from 57 survey locations. Each location was categorised into one of three groups indicating extensive, limited, and no coverage by a smoke-free law. MAIN OUTCOME MEASURES: The proportion of adults with SHS exposure, defined as having serum cotinine levels > or = 0.05 ng/ml. RESULTS: Among non-smoking adults living in counties with extensive smoke-free law coverage, 12.5% were exposed to SHS, compared with 35.1% with limited coverage, and 45.9% with no law. Adjusting for confounders, men and women residing in counties with extensive coverage had 0.10 (95% confidence interval (CI) 0.06 to 0.16) and 0.19 (95% CI 0.11 to 0.34) times the odds of SHS exposure compared to those residing in counties without a smoke-free law. CONCLUSIONS: These results support the scientific evidence suggesting that smoke-free laws are an effective strategy for reducing SHS exposure.

Adult↗
PubMed2006

Cigarette yields and human exposure: a comparison of alternative testing regimens.

OBJECTIVE: There is general agreement that the testing protocol for measuring cigarette smoke constituents-the International Organization for Standardization regimen-is an inappropriate mechanism for evaluating human exposure. Alternative smoking regimens have been introduced in Canada and Massachusetts; however, these regimens have not been evaluated against human smoking behavior and biomeasures of exposure. The objective of this study was to compare measures of smoke volume and nicotine uptake among human smokers against the puffing variables and nicotine yields generated by five different machine smoking regimens: (a) International Organization for Standardization, (b) Massachusetts, (c) Canadian, (d) a Compensatory regimen, and (e) a Human Mimic regimen. METHODS: Measures of smoke volume and puffing behavior were recorded for 51 smokers who used a portable smoking topography device for three 1-week trials. Measures of salivary cotinine were taken at the completion of each week. The cigarette brands smoked by participants were then machine-smoked under five testing regimens, including a human mimic condition where brands were machine smoked using the puffing behavior recorded from human smokers. The total volume of smoke collected from each cigarette and the nicotine, tar, and carbon monoxide yields were recorded. RESULTS: None of the four machine smoking regimens adequately reflected Human Mimic Yields of tar, nicotine, and carbon monoxide. In addition, none of the four smoking regimens generated nicotine yields that were associated with actual nicotine uptake in humans. CONCLUSIONS: None of the existing smoking regimens adequately represents human smoking behavior nor do they generate yields associated with human measures of nicotine uptake.

Adult↗
PubMed2005

The potential impact of a low-nitrosamine smokeless tobacco product on cigarette smoking in the United States: estimates of a panel of experts.

OBJECTIVE: To predict the impact on tobacco use in the US of a "harm reduction" policy that requires that the smokeless tobacco product meet low nitrosamine standards, but could be marketed with a warning label consistent with the evidence of relative health risks. METHODS: Low nitrosamine smokeless tobacco (LN-SLT) and cigarette use are predicted by a panel of experts using a modified Delphi approach. We specify a thought experiment to isolate the changes that would occur after the new LN-SLT policy was implemented. RESULTS: The panel predicted that the new policy would accelerate a decrease in smoking prevalence from 1.3 to 3.1 percentage points over 5 years compared to the current SLT product policy, with greater effects on males than females. Introduction of the new product was also predicted to result in modest additional use of SLT overall, with the greatest increases among males who initiated tobacco use under the new policy. CONCLUSION: An overall consensus was reached that the introduction of a new LN-SLT product under strict regulations would increase SLT use, but reduce overall smoking prevalence. This reduction would likely yield substantial health benefits, but uncertainties surround the role of marketing and other tobacco control policies.

Adolescent↗
PubMed2005

Smoker awareness of and beliefs about supposedly less-harmful tobacco products.

BACKGROUND: Cigarette manufacturers in the United States have begun marketing cigarette brands claiming to reduce smokers' exposure to selected toxins in tobacco smoke. Little data exist on smokers' awareness, use, and beliefs about these products. METHODS: Data from the U.S. arm of the International Tobacco Control Policy Four-Country Survey (ITC-4), a telephone survey of 2028 adult current cigarette smokers in the United States conducted between May and September 2003, were analyzed. Respondents were asked to report their awareness, beliefs, and use of products marketed as less harmful than traditional cigarettes and of smokeless tobacco (SLT) products. RESULTS: Close to 39% of smokers were aware of "less-harmful" cigarettes, but only 27% of them could name a specific brand of such cigarettes. The brand named most often was Quest (25.7%), followed by Eclipse (7.6%), Winston (5.7%), herbal cigarettes (3.3%), "smoke-free" cigarettes (2.9%), Marlboro Blend #27 (1.9%), and Omni (1.9%). Of those who named a brand, 25% believed such products were less harmful than "ordinary cigarettes." In contrast, 82% of cigarette smokers were aware of SLT products, but only 10.7% of these believed that SLTs were less harmful than ordinary cigarettes. CONCLUSIONS: Smokers hold beliefs about the relative safety of supposedly less-harmful tobacco products that are opposite to existing scientific evidence. These results highlight the need to educate smokers about the risks of alternatives to conventional cigarettes, and the need to regulate the advertising and promotion of such alternatives.

Adult↗
PubMed2005

Reduction in amount smoked predicts future cessation.

The goal of this article is to determine whether reducing cigarette consumption increases the likelihood of future cessation. Data from 3,385 participants who originally took part in the Community Intervention Trial for Smoking Cessation completed detailed tobacco use phone surveys in 1988, 1993, and 2001. Between 1988 and 1993, 15% of smokers reduced their daily cigarette consumption by 50% or more, and 9% of the entire baseline sample maintained this reduction in 2001. Those who reduced more than 50% were 1.7 times more likely to quit smoking by 2001 compared with those who did not reduce. Few smokers are able to reduce their consumption by 50% or more, although those who do are more likely to quit compared with those who do not.

Adult↗
PubMed2005

Characteristics of low-level smokers.

Average daily cigarette consumption has decreased, and some evidence suggests that the rate of "some day" smoking has increased; however, relatively little is known about low-level smokers. The present analysis describes and compares low-level versus heavier smokers, using cross-sectional and longitudinal data. Data from the Community Intervention Trial for Smoking Cessation (COMMIT) were used in this analysis. Population-based cross-sectional tobacco use telephone surveys were performed in 22 North American communities in 1988 and 1993, and the prevalence and characteristics of low-level smoking and reasons for quitting are reported from the 1993 prevalence survey. In addition, a cohort of 6,603 smokers was identified in 1988 and interviewed again in 1993 and 2001 to assess patterns of low-level smoking over time and its association with smoking cessation. In 1988, 7.6% were low-level smokers; in 1993, 10.7% were low-level smokers. Compared with heavier smokers, low-level smokers were more likely to be female, older, not married, Black or Hispanic; to have a 4-year college degree; to have no other adult smokers in the household; and to wait longer in the day to have their first cigarette. Low-level smokers also were less likely to report trying to quit because of the expense of smoking or physician advice to quit. They were more likely to try to quit because of trying to set a good example; concern for second-hand smoke; and factors such as bad breath, smell, or the taste of smoking. Those who smoked full-priced premium brands and who worked in a completely smoke-free worksite were more likely to be low-level smokers. Compared with heavier smokers, low-level smokers had similar rates of making a future quit attempt, lower use rates of nicotine replacement therapy, and higher cessation rates. Low-level smokers may be a growing segment of the smoker population and have different characteristics, health risks, and intervention needs compared with their heavier smoking counterparts.

Adult↗
PubMed2005

Methods to assess potential reduced exposure products.

The availability of tobacco products purported to reduce toxin exposure or potentially reduce health risks necessitates the development of methods and identification of biomarkers that can be used to assess these products. These assessments occur on multiple levels and stages, from identifying constituents in the tobacco products and smoke, to human exposure and health effects trials, to postmarketing surveillance. A conference of multidisciplinary experts was convened to present and discuss methods and biomarkers to assess these products and to consider the infrastructure necessary to facilitate the evaluation process. Although no currently available set of measures was thought to be sufficient for determining the relative health risk of potential reduced exposure products, this paper provides a blueprint for future research toward this end.

Biomarkers↗
PubMed2005

State tobacco control spending and youth smoking.

OBJECTIVE: We examined the relationship between state-level tobacco control expenditures and youth smoking prevalence and cigarette consumption. METHODS: We estimated a 2-part model of cigarette demand using data from the 1991 through 2000 nationally representative surveys of 8th-, 10th-, and 12th-grade students as part of the Monitoring the Future project. RESULTS: We found that real per capita expenditures on tobacco control had a negative and significant impact on youth smoking prevalence and on the average number of cigarettes smoked by smokers. CONCLUSIONS: Had states represented by the Monitoring the Future sample and the District of Columbia spent the minimum amount of money recommended by the Centers for Disease Control and Prevention, the prevalence of smoking among youths would have been between 3.3% and 13.5% lower than the rate we observed over this period.

Adolescent↗
PubMed2005

Access to low-taxed cigarettes deters smoking cessation attempts.

We examined whether smokers who purchased low-taxed cigarettes from American Indian reservations had lower quit attempt and cessation rates than did smokers who purchased cigarettes from full-price outlets. Smokers who bought cigarettes from American Indian reservations were half as likely to make a quit attempt and had a nonsignificant trend toward lower cessation rates (20% vs 10%) compared with those who bought full-priced cigarettes. Interventions that reduce price differentials are suggested to maximize the public health benefit of cigarette excise taxes.

Adult↗
PubMed2004

Opportunities for youth smoking cessation: findings from a national focus group study.

To identify opportunities for smoking cessation among adolescents, we conducted six computer-assisted telephone focus groups with 48 male and female high school student smokers and former smokers from six states across the United States, all aged 15-17 years, in two groups each of "established smokers," "late experimenters," and "quitters." These adolescents considered addiction to cigarettes real, powerful, stealthy, insidious, harmful, and avoidable. They considered quitting smoking achievable and desirable. Many of the established smokers and some experimenters would not consider quitting until an indefinite future, when they expected adult responsibilities to help them quit. Quitters had been encouraged by friends who did not smoke around them or offer them cigarettes; they also associated more with nonsmoking friends. Some adolescents, especially quitters, reported that parents had tried to help them quit; some smokers reported that parents had provided them with cigarettes. Some adolescents reported school rules and enforcement that made it hard to smoke; others reported school rules and enforcement that made it easy and tempting to smoke. These adolescents were not aware of the availability of professional help or interested in it. Many did not consider smoking urgent or "intense" enough for professional help. Perceptions of cessation programs were nonexistent or negative. Participants were aware of nicotine replacement therapies but less so of prescription medications. These findings suggest that it is critical to educate adolescents about what good cessation programming is and is not, why it is needed, how it might help, and where it is offered.

Adolescent↗
PubMed2004

Self-reported cigarette smoking vs. serum cotinine among U.S. adolescents.

No national data have been used to compare self-reported and biochemically assessed cigarette smoking status among adolescents. We investigated discrepancies between self-reported smoking and measurement of serum cotinine concentration among adolescents aged 12-17 years in a representative sample (n=2,107) of the U.S. population. Smoking prevalence was 12.9% among teens who reported in a private interview whether they smoked during the previous 5 days (95% CI=10.9%-14.9%) and 12.5% (95% CI=10.3%-14.7%) according to serum cotinine concentration greater than 11.40 ng/ml (the cutpoint). Among teens who reported being a nonsmoker (i.e., that they did not smoke during the previous 5 days), 2.7% (95% CI=1.6%-3.8%) had a serum cotinine concentration of greater than 11.40 ng/ml. Discrepancies among self-reported nonsmokers were less likely among Mexican Americans than among Whites. Among self-reported smokers, 21.1% (95% CI=13.7%-28.5%) had a serum cotinine concentration of 11.40 ng/ml or less. This discrepancy is explained primarily by the high proportion (37.0%) of teen smokers who reported smoking, on average, less than 1 cigarette per day. We believe that social stigma or fear that their parents would find out about their survey responses may be the main explanation for the 2.7% discrepancy among self-reported nonsmokers, and that smoking patterns (including the extent of nicotine dosing) and a lack of measurement of recency of cigarette smoking are the main explanations for the 21.1% discrepancy among self-reported smokers. Efforts to improve the validity of self-reported cigarette smoking will benefit tobacco-related surveillance, evaluation, and research activities for adolescents.

Adolescent↗
PubMed2004

Stop-smoking medications: who uses them, who misuses them, and who is misinformed about them?

This study assessed smokers' beliefs about nicotine and the safety of nicotine medications and examined how these beliefs influence the use of nicotine medications. The data for this paper came from a nationally representative, random-digit-dialed telephone survey of 1,046 adults (18 years of age and older) current cigarette smokers conducted between May and September 2001. Respondents were questioned about their use of stop smoking medications, beliefs about nicotine, and the safety/efficacy of nicotine medications. Nearly all adult smokers in our survey had heard of nicotine patches (97%) or gum (94%), with lower levels of awareness reported for the nicotine inhaler (41%), and nasal spray (9%). Thirty-eight percent of smokers had previously used nicotine medications, with the nicotine patch being the most commonly used medication. The data reveal that most smokers are misinformed about the health risks of nicotine and the safety/efficacy of nicotine medications. Approximately half incorrectly reported that the reduction in nicotine in cigarettes has made cigarettes less dangerous to health and only one-third correctly reported that nicotine patches were less likely to cause a heart attack than smoking cigarettes. Smokers who were more knowledgeable about the health risks of nicotine and the safety and efficacy of nicotine medications were more likely to report past use of nicotine medications. Misperceptions about the health risks of nicotine and the safety/efficacy of nicotine medications may discourage some smokers from considering the use of these medications to help them stop smoking.

Adult↗
PubMed2004

What do Marlboro Lights smokers know about low-tar cigarettes?

The present study examined the extent to which Marlboro Lights smokers perceive lower health risks associated with using a low-tar cigarette and the extent to which they are aware of filter vents in their cigarettes. The data for this study came from a nationally representative random-digit-dialed telephone survey of 1,046 adult current cigarette smokers (aged 18 years or older) conducted between May and September 2001. Respondents were asked about the brand and type of cigarettes smoked, beliefs about the health benefits associated with low-tar and filtered cigarettes, and awareness of ventilation holes in the filters of their cigarettes. Marlboro Lights was the most popular brand, smoked by 19% of survey respondents. Only 32% of Marlboro Lights smokers reported that the filters on their cigarettes were ventilated. Many Marlboro Lights smokers believed incorrectly that lower tar, light, and ultra-light cigarettes were less harmful compared with higher tar, full-flavored cigarettes. For example, only 11% of Marlboro Lights smokers knew that the tar delivery of a light cigarette was about the same as that of a full-flavored cigarette. The responses of Marlboro Lights smokers to questions about the hazards of low-tar cigarettes were similar to those expressed by smokers of other cigarette brands. The data presented in this paper reveal that smokers of the leading light cigarette brand sold in the United States today, Marlboro Lights, are for the most part unaware of filter vents in the cigarettes they smoke and are misinformed about the health risk of using low-tar and filtered cigarettes.

Adult↗
PubMed2004

Are smokers adequately informed about the health risks of smoking and medicinal nicotine?

The present study assessed smokers' beliefs about the health risks of smoking and the benefits of smoking filtered and low-tar cigarettes, and their awareness of and interest in trying so-called reduced-risk tobacco products. Results were based on a nationally representative random-digit-dialed telephone survey of 1,046 adult (aged 18 years or older) current cigarette smokers. Data were gathered on demographic characteristics, tobacco use behaviors, awareness and use of nicotine medications, beliefs about the health risks of smoking, content of smoke and design features of cigarettes, and the safety and efficacy of nicotine medications. In addition, respondents were asked about their interest in and perceived ability to stop smoking and about their desire for more information about the health risks of smoking. Smokers were least knowledgeable about low-tar and filter cigarettes (65% of responses were incorrect or "don't know") and most knowledgeable about the health risks of smoking (39% of responses were incorrect or "don't know"). The smokers' characteristics most commonly associated with misinformation when all six indices were combined into a summary index were as follows: those aged 45 years or older, smokers of ultralight cigarettes, smokers who believe they will stop smoking before they experience a serious health problem caused by smoking, smokers who have never used a stop-smoking medication, and smokers with a lower education level. Those who believed they would stop smoking in the next year were more knowledgeable about smoking. Some 77% of respondents reported a desire for additional information from tobacco companies on the health dangers of smoking. The present findings demonstrate that smokers are misinformed about many aspects of the cigarettes they smoke and stop-smoking medications and that they want more information about ways to reduce their health risks.

Adult↗
PubMed2004

Predictors of cessation in a cohort of current and former smokers followed over 13 years.

The present study attempted to identify predictors of smoking cessation in a cohort of cigarette smokers followed over 13 years. Data are reported on 6,603 persons who resided in one of 20 U.S. communities involved in the National Cancer Institute's Community Intervention Trial for Smoking Cessation (COMMIT) study, were current smokers in the COMMIT trial in 1988, and completed detailed tobacco use telephone surveys in 1988, 1993, and 2001. A person was classified as a former smoker if at the time of follow-up he or she reported not smoking for at least 6 months prior to the interview. Reasons and methods for quitting also were assessed in 1993 and 2001. Among smokers in 1988, 24% had stopped smoking by 1993 and 42% were not smoking by 2001. The most frequently cited reasons for quitting were health and cost reasons, while assisted methods to quit were more common in more recent years. Measures of nicotine dependence were much more strongly associated with cessation than measures of motivation. Other predictors included male gender, older age, higher income, and less frequent alcohol consumption, although the gender effect no longer existed when cessation from cigarettes as well as other tobacco products was considered as the outcome. The present study shows that nicotine dependence is a major factor predicting long-term cessation in smokers. This finding has implications for tobacco control policy and treatment approaches.

Adult↗