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Biomedical subjects

Martin J Jarvis

Publications and source records attributed to Martin J Jarvis.

17 recordsLinked to original sources

UK smokers' and ex-smokers' reactions to cigarettes promising reduced risk.

AIMS: This study evaluated the impact of exposure to information about a novel cigarette claiming to reduce exposure to tobacco toxins ('potential reduced exposure product' cigarette or PREP-C) on smokers' and ex-smokers' perceptions of PREP-C, on quit interest among smokers and on interest in resuming smoking among ex-smokers. DESIGN AND PARTICIPANTS: A random digit-dialed telephone survey was conducted in the United Kingdom with 500 current smokers and 106 ex-smokers who had quit within the last 2 years. INTERVENTION: The interviewer described a novel cigarette that claimed to significantly reduce exposure to smoke toxins. MEASUREMENTS: Respondents' interest in purchasing the PREP-C, beliefs about its safety and risk reduction and smokers' quit interest, as measured by stage of change, before and after exposure to PREP-C information. FINDINGS: Among smokers, 76.5% were interested in purchasing PREP-C; interest did not vary by stage of change. Almost all smokers (90.6%) thought PREP-C was safer than regular cigarettes, with 5.4% indicating that the health risks were equivalent to not smoking at all. Exposure to PREP-C description did not change quit interest. Among ex-smokers, 5.6% believed PREP-C carried no health risk and 7.1% expressed purchase interest. CONCLUSIONS: Smokers and ex-smokers interpreted claims of reduced toxin exposure as reduced health risk and responded positively towards PREP-Cs. With the increasing introduction of PREP-Cs world-wide, evaluation of these products and their claims on quitting among smokers and on relapse among ex-smokers is a matter of public health urgency.

Adult↗

Social inequalities in male mortality, and in male mortality from smoking: indirect estimation from national death rates in England and Wales, Poland, and North America.

BACKGROUND: There are substantial social inequalities in adult male mortality in many countries. Smoking is often more prevalent among men of lower social class, education, or income. The contribution of smoking to these social inequalities in mortality remains uncertain. METHODS: The contribution of smoking to adult mortality in a population can be estimated indirectly from disease-specific death rates in that population (using absolute lung cancer rates to indicate proportions due to smoking of mortality from certain other diseases). We applied these methods to 1996 death rates at ages 35-69 years in men in three different social strata in four countries, based on a total of 0.6 million deaths. The highest and lowest social strata were based on social class (professional vs unskilled manual) in England and Wales, neighbourhood income (top vs bottom quintile) in urban Canada, and completed years of education (more than vs less than 12 years) in the USA and Poland. RESULTS: In each country, there was about a two-fold difference between the highest and the lowest social strata in overall risks of dying among men aged 35-69 years (England and Wales 21%vs 43%, USA 20%vs 37%, Canada 21%vs 34%, Poland 26%vs 50%: four-country mean 22%vs 41%, four-country mean absolute difference 19%). More than half of this difference in mortality between the top and bottom social strata involved differences in risks of being killed at age 35-69 years by smoking (England and Wales 4%vs 19%, USA 4%vs 15%, Canada 6%vs 13%, Poland 5%vs 22%: four-country mean 5%vs 17%, four-country mean absolute difference 12%). Smoking-attributed mortality accounted for nearly half of total male mortality in the lowest social stratum of each country. CONCLUSION: In these populations, most, but not all, of the substantial social inequalities in adult male mortality during the 1990s were due to the effects of smoking. Widespread cessation of smoking could eventually halve the absolute differences between these social strata in the risk of premature death.

Adult↗

Development of adiposity in adolescence: five year longitudinal study of an ethnically and socioeconomically diverse sample of young people in Britain.

OBJECTIVE: To examine the developmental trajectory of obesity in adolescence in relation to sex, ethnicity, and socioeconomic status. DESIGN: Five year longitudinal cohort study of a socioeconomically and ethnically diverse sample of school students aged 11-12 years at baseline. SETTING: 36 London schools recruited to the study in 1999 by a stratified random sampling procedure. PARTICIPANTS: 5863 students participated in one or more years. MAIN OUTCOME MEASURES: Weight, height, and waist circumference measured annually by trained researchers; overweight and obesity defined according to International Obesity Task Force criteria; adiposity and central adiposity indexed by body mass index (BMI) and waist standard deviation scores relative to 1990 British reference values. RESULTS: In school year 7 (age 11-12), the prevalence of overweight and obesity combined was almost 25%, with higher rates in girls (29%) and students from lower socioeconomic backgrounds (31%) and the highest rates in black girls (38%). Prevalence of obesity increased over the five years of the study at the expense of overweight, but no reduction occurred in the proportion of students with BMIs in the healthy range. Waist circumferences were high compared with 1990 norms at age 11 (by 0.79 SD in boys and by 1.15 SD in girls) and increased further over time. Both BMI and waist circumference tracked strongly over the five years. CONCLUSIONS: Prevalence of overweight and obesity was high in London school students, with significant socioeconomic and ethnic inequalities. Little evidence was found of new cases of overweight or obesity emerging over adolescence, but few obese or overweight adolescents reduced to a healthy weight. The results indicate that persistent obesity is established before age 11 and highlight the need to target efforts to prevent obesity in the early years.

Adipose Tissue↗

Prevention of relapse after quitting smoking: a systematic review of trials.

BACKGROUND: After initially successful quit attempts, many people return to smoking within a year, reducing the public health benefits of investment in smoking cessation. We aimed to assess whether interventions designed to prevent relapse after a successful quit attempt reduce the proportion of recent quitters who return to smoking. METHODS: We searched the Cochrane Tobacco Addiction Review Group trials' register. We selected randomized or quasi-randomized controlled trials of relapse prevention interventions with a minimum follow-up of 6 months. We included people who quit on their own, underwent enforced abstinence, or were in treatment programs. We included trials comparing relapse prevention interventions with no intervention or cessation plus relapse prevention with cessation intervention alone. Two of us independently extracted data from each report, with disagreements referred to a third author. RESULTS: Forty-two studies met the inclusion criteria. The most common interventions were skills training to identify and resolve tempting situations and extended treatment contact. A few studies tested pharmacotherapy. We separately analyzed studies that randomized abstainers and those that randomized participants before their quit date. Within subgroups of trials, pooled odds ratios ranged from 0.86 to 1.30, and in most analyses, 95% confidence intervals included 1. Most studies had limited power to detect moderate differences between interventions. CONCLUSION: The evidence to date does not support the adoption of skills training or other specific interventions to help individuals who have successfully quit smoking to avoid relapse, but this is an important area for future study.

Clinical Trials as Topic↗

Early dating predicts smoking during adolescence: A prospective study.

AIM: To examine the relationship between dating and smoking behaviour. DESIGN: A 5-year prospective study. SETTING: Thirty-six schools in South London, England. PARTICIPANTS: A socio-economically and ethnically diverse sample of students (n = 4319 at baseline) took part in the study, providing annual assessments from age 11-16 years. MEASUREMENTS: Questionnaire items assessed dating status, smoking status, friends and family smoking, psychological wellbeing, popularity and conduct, pubertal status, gender, ethnicity and deprivation. Cotinine assays provided biochemical verification of smoking status. FINDINGS: At age 11-12, 18% [corrected] of girls and 29% [corrected] of boys reported having a boyfriend or girlfriend. Logistic regressions showed being an early 'dater' to be a strong predictor of later smoking uptake at each study year, with odds ratios ranging from 3.03 to 8.96 among girls and 1.87 to 5.85 among boys. These associations remained significant after controlling for potential confounding factors, including past smoking and pubertal stage. There was minimal evidence that having smoked by age 11-12 predicted later dating. CONCLUSIONS: The association between early dating and later smoking is strong, and not explained by obvious confounders or dependent on the influence of past smoking experience. The use of smoking to maintain a popular image, and the link between both behaviours and aspirations towards maturity, are potential explanations for the effect. Identification of adolescents dating early could help to target prevention of later smoking uptake.

Adolescent↗

CYP2A6, MAOA, DBH, DRD4, and 5HT2A genotypes, smoking behaviour and cotinine levels in 1518 UK adolescents.

OBJECTIVES: Smoking is a major cause of death and often initiates in adolescence. Mutations in CYP2A6 slow metabolism of nicotine to cotinine. Haploinsufficiency in adults is associated with lower cigarette consumption, lower cotinine level and higher quit rates. Other genes are also implicated in smoking behaviour. We explored smoking behaviour and cotinine levels in relation to genotypes in adolescents. METHODS: 1518 subjects from the Ten Towns Heart Health Study were genotyped for CYP2A6 alleles *1A, *1B, *2, *4, *5, *9 and *12 to classify predicted nicotine metabolism rate. DBH(rs77905), MAOA(rs1801291+VNTR), DRD4(VNTR) and 5HT2A(rs6313) were also studied. Smoking status was established by questionnaire and salivary cotinine measurement at 13-15 and 18 years. RESULTS: No significant associations were identified for DBH, MAOA, DRD4 and 5HT2A markers, with smoking status or cotinine level at either age. At age 18, haploinsufficiency (HI) for CYP2A6 was associated with a higher odds of being a current smoker compared with the *1B carriers (WT1B) (OR = 2.23 (1.16, 4.27) for current versus ex); *1A homozygotes (WT1A) were also at slightly higher risk (OR = 1.44 (1.01, 2.06)). Partial haploinsufficiency (PHI) was not associated with being a current smoker. There were no significant associations at age 13-15. PHI and HI were associated with higher cotinine levels amongst smokers at both 13-15 and at 18 years compared with WT1B and WT1A groups. CONCLUSIONS: CYP2A6 haploinsufficiency increases likelihood of continuing smoking in teenagers. We hypothesize an explanatory 'occupancy' model to explain why haploinsufficiency results in faster progression to nicotine dependence, but lower subsequent consumption.

Adolescent↗

Passive smoking and risk of coronary heart disease and stroke: prospective study with cotinine measurement.

OBJECTIVE: To examine the associations between a biomarker of overall passive exposure to tobacco smoke (serum cotinine concentration) and risk of coronary heart disease and stroke. DESIGN: Prospective population based study in general practice (the British regional heart study). PARTICIPANTS: 4729 men in 18 towns who provided baseline blood samples (for cotinine assay) and a detailed smoking history in 1978-80. MAIN OUTCOME MEASURE: Major coronary heart disease and stroke events (fatal and non-fatal) during 20 years of follow up. RESULTS: 2105 men who said they did not smoke and who had cotinine concentrations < 14.1 ng/ml were divided into four equal sized groups on the basis of cotinine concentrations. Relative hazards (95% confidence intervals) for coronary heart disease in the second (0.8-1.4 ng/ml), third (1.5-2.7 ng/ml), and fourth (2.8-14.0 ng/ml) quarters of cotinine concentration compared with the first (> or = 0.7 ng/ml) were 1.45 (1.01 to 2.08), 1.49 (1.03 to 2.14), and 1.57 (1.08 to 2.28), respectively, after adjustment for established risk factors for coronary heart disease. Hazard ratios (for cotinine 0.8-14.0 nu > or = 0.7 ng/ml) were particularly increased during the first (3.73, 1.32 to 10.58) and second five year follow up periods (1.95, 1.09 to 3.48) compared with later periods. There was no consistent association between cotinine concentration and risk of stroke. CONCLUSION: Studies based on reports of smoking in a partner alone seem to underestimate the risks of exposure to passive smoking. Further prospective studies relating biomarkers of passive smoking to risk of coronary heart disease are needed.

Adult↗

Why people smoke.

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Chronic Disease↗

Public interest in genetic testing for susceptibility to heart disease and cancer: a population-based survey in the UK.

BACKGROUND: Given the current concerns about the clinical validity of commercially marketed genetic tests for multifactorial diseases, there is a surprising dearth of information about what public demand might be for genetic tests for any complex diseases other than cancer. The aim of this study was to examine interest in genetic testing for the most common multifactorial disease, heart disease, and to compare it with interest in testing for cancer in a general population sample that had not received detailed information about genetic tests. METHODS: Interest in genetic testing for heart disease susceptibility was surveyed and compared to interest in genetic testing for cancer susceptibility among a nationally representative sample of 1,960 British adults as part of the Office for National Statistics Omnibus survey. RESULTS: Sixty-nine percent of respondents expressed interest in being tested for genetic susceptibility to heart disease. Men, people aged 45-60 years, those with less education, and those with a family history were most interested in genetic testing for heart disease. Sixty-four percent of respondents expressed interest in genetic testing for susceptibility to cancer, and gender, age, and education, but not family history, were associated with interest. CONCLUSIONS: Interest in genetic testing for susceptibility to both heart disease and cancer was high, with the most educated individuals being the least interested in testing. Although the shift toward the 'expert patient' is actively encouraged and consistent with today's health policies, there is considerable and justifiable concern about some of the genetic tests for multifactorial diseases that are currently being marketed directly to the public. The high level of initial interest in the general public found in this study supports the need for a public education program around genetic testing for multifactorial diseases.

Adolescent↗

Prevalence of hardcore smoking in England, and associated attitudes and beliefs: cross sectional study.

OBJECTIVE: To quantify the prevalence and characteristics of hardcore smokers in England. DESIGN: Cross sectional survey. SETTING: Interview in respondents' household. PARTICIPANTS: 7766 adult cigarette smokers. MAIN OUTCOME MEASURES: Hardcore smoking defined by four criteria (less than a day without cigarettes in the past five years; no attempt to quit in the past year; no desire to quit; no intention to quit), all of which had to be satisfied. RESULTS: Some 16% of all smokers were categorised as hardcore. Hardcore smoking was associated with nicotine dependence, socioeconomic deprivation, and age, rising from 5% in young adults aged 16-24 to 30% in those aged >or= 65 years. Hardcore smokers displayed distinctive attitudes towards and beliefs about smoking. In particular they were likely to deny that smoking affected their health or would do so in the future. Prevalence of hardcore smoking was almost four times higher than in California. CONCLUSION: Hardcore smoking presents a serious challenge to public health efforts to reduce the prevalence of smoking, but the proportion of hardcore smokers does not necessarily increase as overall prevalence in a population declines. More hardcore smokers could be persuaded to quit, but this will require interventions that are targeted to the particular needs and perceptions of both socially disadvantaged and older smokers.

Adolescent↗

Stress and dietary practices in adolescents.

Baseline data from the Health and Behavior in Teenagers Study (HABITS) were used to investigate associations between stress and dietary practices in a socioeconomically and ethnically diverse sample of 4,320 schoolchildren (mean age = 11.83 years). Male (n = 2,578) and female (n = 1,742) pupils completed questionnaire measures of stress and 4 aspects of dietary practice (fatty food intake, fruit and vegetable intake, snacking, and breakfast consumption) and also provided demographic and anthropometric data. Multivariate analyses revealed that greater stress was associated with more fatty food intake, less fruit and vegetable intake, more snacking, and a reduced likelihood of daily breakfast consumption. These effects were independent of individual (gender, weight) and social (socioeconomic status, ethnicity) factors. Stress may contribute to long-term disease risk by steering the diet in a more unhealthy direction.

Adolescent↗

Monitoring cigarette smoking prevalence in Britain in a timely fashion.

BACKGROUND: Available estimates of cigarette smoking prevalence from the General Household Survey (GHS), the source of official smoking data in Britain, can be over a year out of date. With a number of policy initiatives being undertaken at national level, it would be useful to be able to track changes in a more timely manner. AIMS AND DESIGN: We compared prevalence estimates from the Omnibus Survey, a monthly survey conducted by the Office for National Statistics, with those from the General Household Survey in order to examine whether they may provide a complementary and more timely source of cigarette smoking prevalence data. FINDINGS: The age and socio-economic structure of the samples from the Omnibus and GHS surveys was very similar. When data from monthly Omnibus Surveys for the year 2000 were combined, prevalence estimates were within 1% point of those from the GHS for 2000, and overall sample sizes were also similar. The Omnibus data show a significant linear decline in prevalence between 1999 and 2002 of about 0.4% per year. This coincides with the introduction of a national strategy for reducing smoking prevalence. CONCLUSIONS: The Omnibus Survey can be a useful additional tool for assessing changes in smoking prevalence.

Adolescent↗

Measuring nicotine intake in population surveys: comparability of saliva cotinine and plasma cotinine estimates.

Both plasma and saliva cotinine levels have been reported in surveys of smoking behavior, and it is of interest to know how closely these two measures correspond. Plasma and saliva specimens were gathered from a sample of 605 respondents in the 1998 Health Survey for England and assayed for cotinine by a well-proven gas chromatographic method. Plasma and saliva cotinine concentrations were highly correlated (r=.99). On average, concentrations in saliva were 25% higher than in plasma, and this ratio applied both at the low levels attributable to passive smoking and across the range of active smoking values. The ratio was somewhat lower in younger people than in older people and also varied significantly by body mass index but did not differ by gender. Calculation of the limits of agreement revealed substantial uncertainty in the predicted plasma value corresponding to a given saliva cotinine, and vice versa. For comparisons across subjects, the mean plasma cotinine level corresponding to a mean saliva cotinine level can be estimated with confidence, but at the level of the individual, considerable predictive uncertainty remains.

Adolescent↗

Cigarette smoking and cognitive decline in midlife: evidence from a prospective birth cohort study.

OBJECTIVES: The authors investigated the effects of cigarette smoking on midlife cognitive performance. METHODS: Multiple regression was used to test the association between cigarette smoking and changes in cognitive test scores among male and female members of the British 1946 birth cohort aged between 43 and 53 years. RESULTS: Smoking was associated with faster declines in verbal memory and with slower visual search speeds. These effects were largely accounted for by individuals who smoked more than 20 cigarettes per day and were independent of sex, socioeconomic status, previous (adolescent) cognitive ability, and a range of health indicators. CONCLUSIONS: The present results show that heavy smoking is associated with cognitive impairment and decline in midlife. Smokers who survive into later life may be at risk of clinically significant cognitive declines.

Adult↗

Sex differences in the association of socioeconomic status with obesity.

OBJECTIVES: This study investigated socioeconomic predictors of obesity in men and women. METHODS: Data from the 1996 Health Survey for England were used to compare odds ratios for obesity by education, occupation, and 2 economic markers after control for age, marital status, and ethnicity. RESULTS: Obesity risk was greater among men and women with fewer years of education and poorer economic circumstances and among women, but not men, of lower occupational status. CONCLUSIONS: Higher educational attainment and higher socioeconomic status were associated with a lower risk of obesity in both men and women, whereas higher occupational status was associated with a lower risk only for women. The implications of these findings for understanding causes and prevention of obesity are discussed.

Adolescent↗