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PubMed2001

Measures of maternal tobacco exposure and infant birth weight at term.

This study was undertaken to determine the relation between self-reported number of cigarettes smoked per day and urine cotinine concentration during pregnancy and to examine the relations between these two measures of tobacco exposure and birth weight. Data were obtained from the Smoking Cessation in Pregnancy project, conducted between 1987 and 1991. Cigarette smoking information and urine cotinine concentration were collected for 3,395 self-reported smokers who were receiving prenatal care at public clinics in three US states (Colorado, Maryland, and Missouri) and who delivered term infants. General linear models were used to quantify urine cotinine variability explained by the number of cigarettes smoked per day and to generate mean adjusted birth weights for women with different levels of tobacco exposure. Self-reported number of cigarettes smoked per day explained only 13.9% of the variability in urine cotinine concentration. Birth weight declined as tobacco exposure increased; however, the relation was not linear. The sharpest declines in birth weight occurred at low levels of exposure. Furthermore, urine cotinine concentration did not explain more variability in birth weight than did number of cigarettes smoked. These findings should be considered by researchers studying the effects of smoking reduction on birth outcomes.

Adolescent↗

PubMedDate not supplied

Relationship of organizational characteristics of Canadian workplaces to anti-smoking initiatives.

BACKGROUND: In Canada, with universal single-payer health care insurance and a lower proportion of the gross domestic product going to health care costs, employers may be less motivated than their U.S. counterparts to develop health promotion programs for their employees. This study determined the extent to which nongovernmental workplaces in Canada have made smoking-related information, policies, and programs available to their employees. Several characteristics of those workplaces most likely to have engaged in such activities were identified. METHODS: A secondary analysis of data collected in the 1992 National Workplace Survey was conducted. All Canadian provinces, except Saskatchewan, were included. Dunn and Bradstreet's register of companies was used to select companies randomly from those with 20 or more employees. Questionnaires were distributed to 10000 workplaces. The response rate was 35.5% (N = 3,549). There were no significant differences found between responders and nonresponders in a phone survey. RESULTS: One-half of workplaces reported some kind of smoking-related initiative. Most of the initiatives were smoking policies; only 11.7% of workplaces provided smoking cessation programs. The number of employees and the number of other lifestyle and occupational health and safety programs available are most predictive of smoking-related programs. CONCLUSIONS: If Canadians are going to achieve a smoke-free society, greater efforts to assist smokers to quit will be necessary. The workplace provides an excellent opportunity for such efforts. Health promotion advocates must communicate the cost savings and other benefits to employers garnered from workplace smoking reduction efforts.

Adult↗

PubMed1999

Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and 1994.

OBJECTIVE: To estimate the fall in coronary heart disease (CHD) mortality in Scotland attributable to medical and surgical treatments, and risk factor changes, between 1975 and 1994. DESIGN: A cohort model combining effectiveness data from meta-analyses with information on treatment uptake in all patient categories in Scotland. SETTING AND PATIENTS: The whole Scottish population of 5.1 million, including all patients with recognised CHD. INTERVENTIONS: All cardiological, medical, and surgical treatments, and all risk factor changes between 1975 and 1994. Data were obtained from epidemiological surveys, routine National Health Service sources, and local audits. MAIN OUTCOME MEASURES: Deaths from CHD in 1975 and 1994. RESULTS: There were 15 234 deaths from CHD in 1994, 6205 fewer deaths than expected if there had been no decline from 1975 mortality rates. In 1994, the total number of deaths prevented or postponed by all treatments and risk factor reductions was estimated at 6747 (minimum 4790, maximum 10 695). Forty per cent of this benefit was attributed to treatments (initial treatments for acute myocardial infarction 10%, treatments for hypertension 9%, for secondary prevention 8%, for heart failure 8%, aspirin for angina 2%, coronary artery bypass grafting surgery 2%, and angioplasty 0.1%). Fifty one per cent of the reduction in deaths was attributed to measurable risk factor reductions (smoking 36%, cholesterol 6%, secular fall in blood pressure 6%, and changes in deprivation 3%). Other, unquantified factors apparently accounted for the remaining 9%. These proportions remained relatively consistent across a wide range of assumptions and estimates in a sensitivity analysis. CONCLUSIONS: Medical treatments and risk factor changes apparently prevented or postponed about 6750 coronary deaths in Scotland in 1994. Modest gains from individual treatments produced a large cumulative survival benefit. Reductions in major risk factors explained about half the fall in coronary mortality, emphasising the importance and future potential of prevention strategies.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2000

Effects of nicotine replacement therapy on markers of oxidative stress in cigarette smokers enrolled in a smoking cessation program.

Twenty healthy, asymptomatic long-term cigarette smokers (8 males, 12 females; mean age: 43 +/- 9 years) were selected at random from a larger series receiving nicotine replacement therapy (NRT) for 12 weeks to study the effects of NRT on plasma markers of oxidative stress. Plasma aliquots, obtained at baseline (T0) and after 12 weeks (T12) of NRT, were used to measure malondialdeyde (MDA) and total Trolox-equivalent antioxidant capacity (TEAC). In subjects who completely quit smoking ('quitters', n = 10), MDA was higher at T0 (1.08 mumol/l, interquartile range 0.85-1.16) than at T12 (0.71 mumol/l, range 0.32-0.92; p < 0.01), and TEAC was lower at T0 (1.20 mM, range 1.11-1.31) than at T12 (1.43 mM, range 1.31-1.49; p < 0.05). In subjects who had only reduced the number of cigarettes smoked per day ('reducers', n = 10), differences between the T0 and T12 levels of MDA (0.81 [0.75-0.96] vs. 0.76 [0.58-0.84] mumol/l) and TEAC (1.28 [1.05-1.50] vs. 1.25 [1.09-1.42] mM) were not significant. At T0, MDA and cotinine levels correlated in reducers (r = 0.79, p < 0.05) and, though not significantly, in quitters (r = 0.50, p = 0.12). At T12 this relationship between MDA and cotinine was still present in the reducers (r = 0.70, p < 0.05), while the scatter of points in quitters was completely dispersed (r = (0.09). These results show that smoking cessation but not smoking reduction is associated with decreased markers of oxidative stress in the plasma of active cigarette smokers.

Adult↗

PubMed1989

Randomized, controlled trial of clonidine for smoking cessation in a primary care setting.

Clonidine hydrochloride has been reported to reduce tobacco withdrawal symptoms and facilitate smoking cessation. We enrolled 185 subjects, 92 receiving clonidine and 93 receiving placebo, in a randomized, double-blind study of clonidine for smoking cessation in a primary care setting. Clonidine had no demonstrable effect on withdrawal (8 of 11 measures favoring placebo). At 4 weeks, 17 (18%) subjects receiving clonidine had quit compared with 13 (14%) receiving placebo (chi 2 = 0.7; 90% confidence interval of benefit from clonidine, -4% to 13%). At 4 weeks, the mean number of cigarettes smoked was 17.7 for those receiving clonidine and 17.5 for those receiving placebo (t = 0.1; 90% confidence interval of benefit from clonidine, -4.1 to 3.7 cigarettes per day). These results provide little support for a beneficial effect of clonidine on tobacco withdrawal symptoms, quitting, or smoking reduction in a primary care setting.

Adolescent↗

PubMed2004

A meta-analysis of adolescent psychosocial smoking prevention programs published between 1978 and 1997 in the United States.

Psychosocial smoking prevention studies have shown inconsistent results and theory-driven programs have been related to program success. This meta-analysis was used as a judgment tool for resolving these issues by estimating average program effects and investigating the relative efficacy of program types. The present study examined 65 adolescent psychosocial smoking prevention programs (1978 to 1997) among students in Grades 6 to 12 in the United States. Three program modalities (social influence, cognitive behavior, life skill) and two program settings (exclusively school based, school-community-incorporated) were identified as major a priori classifications. Knowledge had the highest effect sizes (.53) at short-term (< or = 1 year) but rapidly decreased (.19) at long-term (> 1 year). Behavioral effect was the most meaningful, being persistent over a 3-year period (.19 at < or = 1 year; .18 at 1 to 3 years). Adolescent smoking reduction rates were increased by using either cognitive behavior or life skills program modalities, and/or a school-community-incorporated program setting.

Adolescent↗

PubMed1990

Determinants of preterm delivery and intrauterine growth retardation in north-east Brazil.

A case-control study was conducted in Natal, north-east Brazil to determine the risk factors for low birthweight (LBW). Cases were 429 preterm and 422 intrauterine growth retarded (IUGR) singleton infants. Controls were 2555 infants of normal birthweight and gestational age. The prevalence of LBW was 10% (5.1% preterm and 4.9% IUGR). Logistic regression was used to estimate the adjusted odds ratios of LBW, and attributable risk per cent (AR%) was used to estimate the proportion of LBW that might be prevented. The preventable determinants of preterm delivery were births to women less than 20, (AR = 7.1%), low maternal weight less than 50 kg (AR = 20.5%), smoking during pregnancy (AR = 14.6%) and infrequent antenatal visits (AR = 28.1%). Other important determinants of preterm delivery were prior LBW births, gestational illness and vaginal bleeding. The main preventable causes of IUGR were low maternal weight (AR = 17.8%), low maternal education (AR = 11.6%), smoking (AR = 14.8%), and inadequate antenatal care (AR = 11.6%). Other risk factors for IUGR include primiparity, prior LBW births, and illness during gestation. In this population, the focus of short-term preventive programme should be improvement in maternal nutrition, cessation of smoking, reduction of births to women under 20, and improved antenatal care.

Body Weight↗

PubMed2000

Maximizing help for dissonant smokers.

'Consonant' smokers know and accept the risks associated with tobacco consumption, and do not wish to change their smoking, whereas 'dissonant' smokers are tobacco consumers whose attitudes differ from their behaviour. Dissonant smokers have several options: to quit smoking (the optimal solution), reduce their smoking, switch products or brands, or do nothing. To date, nicotine replacement therapy (NRT) is the best-established medical aid to smoking cessation, but several important factors impact on NRT use. As smokers constitute a diverse group there is a need for various different formulations, some of which will suit certain smokers better than others. Smokers should be allowed to select their preferred products in order to increase compliance, and should also be permitted to combine various products if desired. Adequate dosage regimens should be stressed in order to avoid under-dosing, which is common with NRT. It is also essential that the medical system focuses increasingly on the diagnosis and treatment of those smokers who are unable or unwilling to quit smoking. High nicotine dependence correlates with a high risk of pulmonary and cardiovascular disease; because these smokers cannot quit, cessation efforts have little impact on the incidence of tobacco-related diseases in this population. Additional smoking control interventions, such as smoking reduction therapy, are therefore required to treat this group. Our experience in Vienna shows that these smokers can be targeted through approaches that utilize new messages offering alternatives to cessation.

Adolescent↗

PubMed2002

Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial.

BACKGROUND: Smokers are at higher risk of cardiopulmonary and wound-related postoperative complications than non-smokers. Our aim was to investigate the effect of preoperative smoking intervention on the frequency of postoperative complications in patients undergoing hip and knee replacement. METHODS: We did a randomised trial in three hospitals in Denmark. 120 patients were randomly assigned 6-8 weeks before scheduled surgery to either the control (n=60) or smoking intervention (60) group. Smoking intervention was counselling and nicotine replacement therapy, and either smoking cessation or at least 50% smoking reduction. An assessor, who was masked to the intervention, registered the occurrence of cardiopulmonary, renal, neurological, or surgical complications and duration of hospital admittance. The main analysis was by intention to treat. FINDINGS: Eight controls and four patients from the intervention group were excluded from the final analysis because their operations were either postponed or cancelled. Thus, 52 and 56 patients, respectively, were analysed for outcome. The overall complication rate was 18% in the smoking intervention group and 52% in controls (p=0.0003). The most significant effects of intervention were seen for wound-related complications (5% vs 31%, p=0.001), cardiovascular complications (0% vs 10%, p=0.08), and secondary surgery (4% vs 15%, p=0.07). The median length of stay was 11 days (range 7-55) in the intervention group and 13 days (8-65) in the control group. INTERPRETATION: An effective smoking intervention programme 6-8 weeks before surgery reduces postoperative morbidity, and we recommend, on the basis of our results, this programme be adopted.

Adult↗

PubMed2005

Duodenal acidity may increase the risk of pancreatic cancer in the course of chronic pancreatitis: an etiopathogenetic hypothesis.

Chronic pancreatitis patients have an increased risk of developing pancreatic cancer. The cause of this increase has yet to be fully explained but smoking and inflammation may play an important role. To these, we must now add a new potential risk factor, namely duodenal acidity. Patients with chronic pancreatitis very often present pancreatic exocrine insufficiency combined with a persistently low duodenal pH in the postprandial period. The duodenal mucosa in chronic pancreas patients with pancreatic insufficiency has a normal concentration of s-cells and, therefore, the production of secretin is preserved. Pancreatic ductal cells are largely responsible for the amount of bicarbonate and water secretion in response to secretin stimulation. When gastric acid in the duodenum is not well-balanced by alkaline pancreatic secretions, it may induce a prolonged secretin stimulus which interacts with the pancreatic ductal cells resulting in an increased rate of ductular cell activity and turnover. N-Nitroso compounds from tobacco, identified in human pancreatic juice and known to be important carcinogens, may then act on these active cells, thereby increasing the risk of cancer. Duodenal acidity is probably of particular concern in patients who have undergone a duodenum-preserving pancreatic head resection, since, in this anatomic situation, pancreatic juice transits directly via the jejunal loop, bypassing the duodenum. Patients undergoing a Whipple procedure or side-to-side pancreaticojejunostomy are probably less critically affected because secretions transit, at least in part, via the papilla. If the duodenal acidity hypothesis proves correct, then, in addition to stopping smoking, reduction of duodenal acid load in patients with pancreatic insufficiency may help decrease the risk of pancreatic cancer.

Alcohol Drinking↗

PubMed1999

The impact of smoking on future pancreatic cancer: a computer simulation.

BACKGROUND: We studied the impact of several smoking cessation-based scenarios on future pancreatic cancer incidence in the European Union by means of computer simulation. MATERIAL AND METHODS: Among other data, published data on pancreatic cancer incidence rate and smoking prevalence in ten member states of the European Union, and on the relative risk of smoking were entered into a simulation model. Four different scenarios were simulated: one reference scenario, one based on theoretically maximal smoking reduction and two feasible scenarios based on WHO's Health for All targets. In each scenario, pancreatic cancer incidence was computed from 1994 up to the year 2020. Results were extrapolated to the European Union as a whole. RESULTS: When the percentage of smokers remains unchanged, 627,000 and 588,000 newly diagnosed pancreatic cancer cases among males and females respectively will arise in the European Union up to 2020. Theoretically, if all smokers would give up smoking instantly, this number can be reduced by 133,000 cases among men and 43,000 cases among women. In more feasible scenarios up to 35,500 male and 32,500 female pancreatic cancer cases can be prevented. CONCLUSION: Giving up smoking substantially reduces future burden of pancreatic cancer up to almost 68,000 patients in the European Union up to the year 2020.

Computer Simulation↗

PubMed1982

Pilot study: effective health and personal development. An experiment in school education.

This paper describes an experimental school-based health education and personal development programme conducted jointly by the Health Commission and Department of Education in northern Sydney, New South Wales. We evaluated the programme after it had been taught for five school terms, by adopting a control/experimental group design based on multiple choice questionnaires. We recorded large and significant gains in the health status of the secondary students from the experimental schools compared with the control students. Notable successes were in the areas of cigarette smoking (reductions as high as 13%), alcohol consumption (reductions of up to 12%) and exercise (increase of 17.5%). The long-term effectiveness of such programmes may depend on support from the medical profession.

Adolescent↗

PubMed1992

Attributable risks for oesophageal cancer in northern Italy.

The population attributable risk for oesophageal cancer in relation to cigarette smoking, elevated alcohol use and low beta-carotene intake has been estimated with 300 cases and 1203 controls in Greater Milan. In males 71% of oesophageal cancers were attributable to smoking, 45% to elevated alcohol use and 40% to low beta-carotene consumption. The corresponding figures were 32%, 10% and 29% in females and 61%, 39% and 38% in total. The overall estimate, including the joint effect of the three factors, was 90% in males, 58% in females and 83% in total. The discrepancies between the sums are due to the assumption of a multiplicative model and to the great percentage of oesophageal cancers attributable to each single factor. Cigarette smoking is the major known cause of oesophageal cancer and the three factors account for practically all the difference between male and female mortality rates. Elimination of smoking, reduction of alcohol consumption and enrichment of diet with fruit and vegetables would make oesophageal cancer a rare disease in Italians of both sexes.

Adult↗

PubMed1978

Locus of control and health: a review of the literature.

Locus of control, an individual difference construct from social learning theory, has shown some promise in predicting and explaining specific health-related behaviors. Research is reviewed on the utility of the locus of control construct in understanding smoking reduction, birth control utilization, weight loss, information-seeking, adherence to medication regimens, and other health or sick-role behaviors. Implications for health educators are presented.

Attitude to Health↗

PubMed1990

[Secondary prevention of the basic risk factors in patients with a history of myocardial infarction].

160 patients under 60 years of age with a past myocardial infarction, proved clinically and electrocardiographically, were followed up for 3 years during which period a secondary prophylaxis of the basic risk factors was carried out. The smokers were 71.9% and 72.2% of them were over 46 years of age. 65.2% of the smokers gave up smoking after being advised by the authors to do so. Positive changes were found concerning the risk factors under observation in the patients--a statistically significant decrease of the arterial pressure and cholesterol serum level and a considerable increase of the tolerance to physical activity in the non-smokers and the smokers who had given up smoking. Reduction of the frequency of stenocardia attacks, extrasystoles, ST-depression as well as a reduction of the risk of another myocardial infarction were also established. The secondary prophylaxis carried out by the authors in their outpatient practice on patients with past myocardial infarction has proved its efficiency and ought to be recommended.

Bulgaria↗

PubMed1997

Coronary risk factors, endothelial function, and atherosclerosis: a review.

The traditional risk factors for coronary heart disease, which include hypercholesterolemia, hypertension, cigarette smoking, diabetes mellitus, and high-fat diet, have all been associated with impairments in endothelial function. Impaired endothelium function may promote the development of atherosclerosis through its effects on vasoregulation, platelet and monocyte adhesion, vascular smooth muscle cell growth, and coagulation. Increased oxidative stress may be another mechanism by which endothelial dysfunction contributes to atherosclerosis, although controversy exists on this issue. Risk factor modification, particularly lowering elevated concentrations of low-density lipoprotein cholesterol, improves endothelial function. At least seven clinical studies have demonstrated improved endothelial function with cholesterol reductions in patients with markedly elevated or even borderline elevations in cholesterol concentrations, whether or not coronary heart disease is present. Other interventions that improve endothelial function include blood pressure reduction, smoking cessation, and administration of estrogen to postmenopausal women.

Animals↗

PubMed1984

An evaluation of the intervention against smoking in the multiple risk factor intervention trial.

The results of the Multiple Risk Factor Intervention Trial showed no significant difference in mortality from coronary heart disease between intervention and control groups despite an apparent success of the intervention against cigarette smoking. A reanalysis of the published data indicates that the effectiveness of the smoking intervention may have been overestimated. The researchers counted those who smoked pipes or cigars at screen as nonsmokers and attempted to classify cigarette smokers who switched to pipes or cigars during the trial as successes whether or not they continued to inhale the smoke. It is unreasonable to assume a priori that inhaling pipe or cigar smoke is less dangerous than cigarette smoke. Moreover, attempting to include pipe and cigar smokers, who may have been inhaling smoke, among the successes makes biochemical validation of claims of abstinence overly lenient. When levels of serum thiocyanate are used to obtain an objective index of smoking reduction, it appears that the effect of intervention was considerably smaller than has been reported, and failed to reach design goals over the first 4 years. This could help to explain the disappointing mortality results.

Carbon Monoxide↗

PubMed1996

Effect of menthol cigarettes on biochemical markers of smoke exposure among black and white smokers.

STUDY OBJECTIVES: Black smokers have been reported to have higher serum cotinine levels than do white smokers, and have higher rates of most smoking-related diseases, despite smoking fewer cigarettes per day. Another striking racial difference is the preference for mentholated cigarettes among black smokers. The contribution of menthol to variability in biochemical markers of cigarette smoke exposure (end-expiratory carbon monoxide and serum cotinine) was evaluated in a biracial sample. DESIGN: Descriptive cross-sectional. SETTING: A university smoking research laboratory. PARTICIPANTS: Sixty-five black and 96 white adult established smokers who were paid for their participation. MEASUREMENTS: Information was obtained through direct observation, self-report (interview and self-administered questionnaires), measurement of butts collected for a week, and laboratory analyses of the biochemical markers of exposure. RESULTS: Compared with the white smokers, the black smokers had significantly higher cotinine and carbon monoxide levels per cigarette smoked and per millimeter of smoked tobacco rod (both p < 0.001). After adjusting for race, cigarettes per day, and mean amount of each cigarette smoked, menthol was associated with higher cotinine levels (p = 0.03) and carbon monoxide concentrations (p = 0.02). CONCLUSIONS: The use of menthol may be associated with increased health risks of smoking. Menthol use should be considered when biochemical markers of smoke exposure are used as quantitative measures of smoking intensity or as indicators of compliance with smoking reduction programs. In addition, the effect of menthol on total "dose" should be considered in any efforts to regulate the amount of nicotine in cigarettes.

Adolescent↗