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Cutaneous delayed-type hypersensitivity reactions in smokers with chronic bronchitis and recurrent exacerbations: comparison with asymptomatic smokers and never-smokers.

The aim of the present study was to investigate whether smoking patients with chronic bronchitis (CB) and recurrent exacerbations show signs of depressed cell-mediated immunity (CMI), as reflected in the cutaneous delayed-type hypersensitivity (DTH) reaction, in comparison with asymptomatic smokers and healthy never-smokers. The study was a comparative clinical study performed at a university hospital center of respiratory medicine. Sixteen smokers with stable CB and recurrent exacerbations, five of whom had mild airflow obstruction, 18 asymptomatic smokers and 18 healthy never-smokers, all aged between 35 and 64 years, participated. No subjects treated with corticosteroids or N-acetylcysteine were included. Cutaneous DTH-reactions to seven recall antigens were assessed with Multitest, a standardized in vivo test of clinical CMI. Reactions were assessed 48 h after application by measurement of skin induration. A score (sum in mm of positive reactions) was created to assess overall reactivity. Neither the score nor the number of positive reactions differed significantly between the three study groups. Men had a significantly higher reactivity than women (P < 0.05) irrespective of group affiliation. No influence of smoking status on DTH reactivity could be seen. In the CB group no correlation was found between DTH reactivity and number of exacerbations the past 2 years. Patients with chronic bronchitis and recurrent exacerbations did not differ from asymptomatic smokers or healthy never-smokers with respect to cutaneous DTH reactions. Depression of CMI, as measured in this study, does not seem to be a primary factor behind recurrent exacerbations in smokers with CB.

Bronchitis↗

Comparing attentional bias to smoking cues in current smokers, former smokers, and non-smokers using a dot-probe task.

Much evidence documents that individuals with emotional and drug-use disorders demonstrate biased attention toward stimuli associated with their disorder. This bias appears to diminish following successful treatment. Two studies examined whether current cigarette smokers show biased attention toward smoking-related images compared with non-smokers (Studies 1 and 2) and whether this bias is less pronounced in former smokers (Study 2). Attentional bias toward cigarette-related photographs was examined using the dot-probe task. Pairs of images (one smoking-related) appeared side by side for 500 ms on a computer screen prior to the presentation of a probe (an asterisk) replacing one of the photographs. Subjects struck a key as quickly as possible to indicate the probe location. Attentional bias was defined as faster reaction times when the probe replaced the smoking-related image. In both studies, current smokers displayed significantly greater attentional bias toward cigarette stimuli than did non-smokers. Former smokers in Study 2 displayed an intermediate level of bias, but did not differ significantly in bias score from either of the other groups. These results support further use of the dot-probe task as a measure of attentional bias in non-abstinent smokers and in individuals undergoing smoking cessation treatment.

Adult↗

Urinary hydroxyproline excretion in smokers, non-smokers and passive smokers.

The hydroxyproline/creatinine ratio in urine was investigated in 200 cigarette smokers, 199 pipe and/or cigar smokers and 24 non-smokers. For cigarette smokers a statistically significant positive correlation is found between this ratio and daily cigarette consumption, COHb, serum cotinine and nicotine excretion in urine. This smoking-related increase in the hydroxyproline/creatinine ratio is, for the most part or completely, due to the fact that creatinine urine concentrations inversely correlate with the smoke uptake variables. Neither pipe and/or cigar smoking nor passive smoke exposure of non-smokers seem to affect the hydroxyproline/creatinine ratio. A seasonal influence is found in these studies as well as in two experiments with limited numbers of subjects: the hydroxyproline/creatinine ratio is higher in winter than in summer for both smokers and non-smokers. Our data do not favour the idea that measuring hydroxyproline/creatinine ratios in urine is an accurate method of investigating early effects of smoking, passive smoking and air pollution in man.

Adolescent↗

A prospective study of psychological and socioeconomic characteristics, health behavior and morbidity in cigarette smokers prior to quitting compared to persistent smokers and non-smokers.

Psychosocial factors influencing smoking cessation were studied in current smokers prior to quitting. Two questionnaires were sent in 1975 and 1981 to adult members of the Finnish Twin Cohort. The 1975 response rate was 89%, and 89% of those eligible replied again in 1981. Analysis was done on data from one twin pair member only. Three groups were identified: 3617 never smokers, 2654 persistent smokers, and 823 quitters (i.e. current smokers in 1975, former smokers in 1981). Univariate and multivariate comparisons of baseline psychosocial variables for quitters and persistent smokers were performed in men aged 20-34 and 35-54 and women aged 20-39. Among women and young men quitters were better educated and scored lower on neuroticism. Young male quitters also slept longer, had been less often unemployed and drank less alcohol and coffee. Among middle-aged men quitters were more often married, slept longer, and had higher life satisfaction. The possibility that the influence of psychosocial factors on chronic disease may be mediated in part through changes in smoking behavior is discussed.

Adult↗

Morphometric differences between the placental vasculature of non-smokers, smokers and ex-smokers.

The aim of this study was to determine whether cigarette smoking during pregnancy has an adverse effect upon the placenta's capacity for gaseous exchange. Using recently developed stereological techniques, in conjunction with perfusion fixation, computer-assisted measurements were made on the placentas of 15 non-smokers, 15 moderate smokers, 15 heavy smokers and 13 ex-smokers, 7 of whom stopped smoking during the course of the pregnancy. Compared with the placentas of non-smokers and of those who stopped before pregnancy, it was found that the placentas of smokers and of those who stopped after conception exhibited a reduced capillary volume fraction, and an increased thickness of the villous membrane. Although they must impair gaseous exchange across the placenta, these changes were less severe than suggested by previously published reports. Nonetheless it is clear that in order to prevent these changes women should stop smoking before conception rather than during the course of a pregnancy.

Adult↗

Patterns of depressive symptomatology in women smokers, ex-smokers, and never-smokers.

To investigate the possibility that specific symptom patterns contribute differentially to excess depression among smokers, we analyzed Center for Epidemiological Studies-Depression (CES-D) and subscale scores in 931 women current smokers (CS), ex-smokers (ES), and never-smokers (NS). After adjusting for differences in age, education, and marital status, significant group differences were found for the CES-D overall and for Depressed Affect, Anhedonia, and Somatic Features, but not Interpersonal Distress. Both CS and ES scored significantly higher than NS on most measures, whereas differences between CS and ES failed to reach significance. CS were significantly more likely than NS to be taking antidepressants. Alcohol intake also showed significant group differences, with CS>ES>NS, suggesting that the link between current smoking and alcohol intake is mediated by factors other than depression, since CS and ES were comparably depressed. We conclude that studying specific symptom patterns may elucidate the smoking-depression link. Our observation that ES and CS exhibit similar levels of depressive symptomatology further suggests that interventions for depressed smokers need to take into account the likely persistence of depression following cessation.

Adolescent↗

Antimicrobial and respiratory burst characteristics of pulmonary alveolar macrophages recovered from smokers of marijuana alone, smokers of tobacco alone, smokers of marijuana and tobacco, and nonsmokers.

Rodent studies indicate that marijuana smoke can adversely affect the antimicrobial function of pulmonary alveolar macrophages (PAM). To evaluate whether marijuana smoke similarly affects human PAM, we compared phagocytosis, fungistatic/fungicidal activity, and superoxide anion (O2-) production of PAM recovered from marijuana smokers (MS), tobacco smokers (TS), marijuana and tobacco smokers (MTS), and nonsmokers (NS). Although PAM from the four groups were equally capable of ingesting Candida albicans, the macrophages from smokers differed from normal PAM in their ability to restrict intracellular yeast germination (ungerminated candida in smokers' PAM = 68 +/- 3% [46] versus NS = 54 +/- 6% [17], mean +/- SEM [n], p = 0.022). Despite heightened fungistatic activity, PAM from MS and TS destroyed significantly fewer intracellular yeast (28 +/- 2 and 29 +/- 2%, respectively) after 4 h than did macrophages recovered from NS (40 +/- 4%, p less than 0.05). Both basal and stimulated (dihydrocytochalasin B + opsonized zymosan or phorbol myristate acetate) O2- production were similar in PAM from MS and NS, but significantly increased in PAM from TS (p less than 0.05). Our findings indicate that marijuana smoking does not alter the phagocytic behavior or the respiratory burst of human PAM, but marijuana smoking does decrease the ability of human PAM to destroy ingested Candida albicans. These findings contrast with the effects of tobacco smoking, which not only decreases the fungicidal activity of human PAM but also increases their respiratory burst.

Adult↗

Lung cancer pathology in smokers, ex-smokers and never smokers.

The histologic distribution of lung cancer is markedly different in smokers and non-smokers. It is not known whether the histology among former smokers varies according to the number of years since quitting. Using data from a large case-control study of lung cancer, we found that for both men and women, the proportion of adenocarcinomas increased with the number of years since quitting smoking. Among long-term quitters (> 25 years), the proportion of adenocarcinomas was similar to that in never smokers. These findings have implications for studies of environmental tobacco smoke and lung cancer.

Adenocarcinoma↗

Regular smokers, lifetime very light smokers, and reduced smokers: comparison of psychosocial and smoking characteristics in women.

This study compared stable very light smokers (VLS; less than 6 cigarettes a day) with regular smokers (RS; greater than 14 cigarettes a day) in a cohort of women followed up for 1 year. The VLS showed evidence of inhaling the cigarette smoke. They were not novice smokers, nor were they under particular pressure to limit their smoking. Among the 61 VLS, 34 had at one time smoked more than 10 cigarettes per day. These "reduced smokers" were broadly similar to the lifetime VLS, who differed from RS in several important respects. In a multiple logistic regression, education and smoking patterns in relatives were independently associated with very light versus regular smoking. Familial factors and personal resources may protect against dependence among those who use tobacco.

Adult↗

Respiratory bronchiolitis: a clinicopathologic study in current smokers, ex-smokers, and never-smokers.

The clinical and pathologic features of 109 cases of respiratory bronchiolitis (RB) identified from review of 156 consecutive surgical lung biopsy specimens were studied. A total of 107 of the 109 cases (98%) occurred in smokers, including all 83 current smokers and 24 of 49 ex-smokers (49%). RB persisted in some patients for many years after stopping smoking, occurring in one third of patients 5 years after quitting, and in one patient 32 years afterwards. A correlation was found between degree of cytoplasmic pigmentation of macrophages and number of pack-years smoked and also between the presence of peribronchiolar fibrosis and number of pack-years. No correlation was found between pulmonary function test results and pathologic findings. A desquamative interstitial pneumonia-like reaction was observed in six individuals. One patient each with a desquamative interstitial pneumonia-like reaction and one with RB were diagnosed based on clinical findings with desquamative interstitial pneumonia and RB-associated interstitial lung disease, respectively. No histologic features distinguished desquamative interstitial pneumonia from a desquamative interstitial pneumonia-like reaction or RB-associated interstitial lung disease from RB. Five cases of variant RB were encountered that resembled RB except that macrophage cytoplasm lacked pigment. All occurred in never-smokers, and their significance is unknown. RB is an accurate histologic marker of cigarette smoking, and it may be found many years after smoking ceases. There are no reliable histologic features to distinguish RB-associated interstitial lung disease from RB or desquamative interstitial pneumonia-like reactions from desquamative interstitial pneumonia.

Adolescent↗

Respiratory symptoms and lung function in habitual heavy smokers of marijuana alone, smokers of marijuana and tobacco, smokers of tobacco alone, and nonsmokers.

To evaluate the possible pulmonary effects of habitual marijuana smoking with and without tobacco, we administered a detailed respiratory and drug use questionnaire and/or lung function tests to young, habitual, heavy smokers of marijuana alone (n = 144) or with tobacco (n = 135) and control subjects of similar age who smoked tobacco alone (n = 70) or were nonsmokers (n = 97). Mean amounts of marijuana and/or tobacco smoked were 49 to 57 joint-years marijuana (average daily number of joints times number of years smoked) and 16 to 22 pack-years of tobacco. Among the smokers of marijuana and/or tobacco, prevalence of chronic cough (18 to 24%), sputum production (20 to 26%), wheeze (25 to 37%) and greater than 1 prolonged acute bronchitic episode during the previous 3 yr (10 to 14%) was significantly higher than in the nonsmokers (p less than 0.05, chi square). No difference in prevalence of chronic cough, sputum production, or wheeze was noted between the marijuana and tobacco smokers, nor were there additive effects of marijuana and tobacco on symptom prevalence. We noted significant worsening effects of marijuana but not to tobacco on specific airway conductance and airway resistance (tests of mainly large airways function) in men and of tobacco but not of marijuana on carbon monoxide diffusing capacity and on closing volume, closing capacity, and the slope of Phase III of the single-breath nitrogen washout curve (tests reflecting mainly small airways function) (p less than 0.03, two-way ANCOVA). No adverse interactive effects of marijuana and tobacco on lung function were found.

Adult↗

Interleukin 1 and receptor antagonist levels in gingival crevicular fluid in heavy smokers versus non-smokers.

BACKGROUND/AIMS: This study aimed to investigate the concentration of the cytokine interleukin (IL)-1beta and its receptor antagonist IL-1ra in gingival crevicular fluid (GCF) in patients with adult periodontitis who were heavy smokers compared with non-smokers. METHOD: GCF samples were collected from two groups of subjects: smokers and non-smokers. Thirty-nine GCF samples were harvested from 13 subjects with moderate to severe adult periodontitis who were heavy smokers. A further 30 GCF samples were harvested from 10 subjects with moderate to severe adult periodontitis who were non-smokers. Subjects were selected from both genders and none had any relevant systemic illness, were pregnant, had recent medication or had received any periodontal therapy in the preceding 3 months. One deep bleeding site, one deep non-bleeding site and one healthy site were investigated in each subject. Clinical measurements were recorded for each site, after obtaining a GCF sample using a Periopaper strip. IL-1beta and IL-1ra were quantified using new commercially available ELISA kits (Quantikine), and could be detected in all samples. RESULTS: For smokers, the mean concentrations for IL-1beta were 2714.5 (SD 4416.2) pg/ micro L for healthy sites, 37.0 (SD 57.2) pg/ micro L for non-bleeding periodontitis sites and 24.5 (SD 29.2) pg/ micro L for bleeding periodontitis sites. The concentrations of IL-1beta for non-smokers for the same category of sites were 393.8 (SD 867.1), 74.2 (SD 107.0) and 73.1 (SD 61.0) pg/ micro L, respectively. The mean concentrations of IL-1ra for smokers were 5.8 x 10(5) (SD 9.7) pg/ micro L for healthy sites, 2.2 x 10(5) (SD 0.15) pg/ micro L for deep non-bleeding sites and 0.19 x 10(5) (SD 0.07) pg/ micro L for deep bleeding sites. The concentrations for non-smokers were: 4.1 x 10(10) (SD 3.8), 18.1 x 10(5) (SD 20.4) and 3.2 x 10(5) (SD 2.3) pg/ micro L, respectively. Significance levels of P < 0.05 were found for comparisons of healthy vs. deep bleeding and deep non-bleeding sites for IL-1beta and IL-1ra in smokers, before adjustments for multiple testing. However, none of these comparisons reached statistical significance following adjustments for multiple testing. P < 0.05 for the correlation between IL-1beta and IL-1ra at healthy sites in smokers only. Differences in GCF concentrations for IL-1beta in smokers vs. non-smokers were significant for deep bleeding sites only (P < 0.05), the mean concentration of IL-1beta being lower in GCF from smokers vs. non-smokers. All differences in GCF concentrations of IL-1ra reached statistical significance for smokers vs. non-smokers. The mean concentrations of IL-1ra in GCF were lower in smokers compared with non-smokers for all categories of sites. CONCLUSIONS: A decreased concentration of IL-1beta and also IL-1ra was found in GCF from periodontitis sites compared to healthy sites in smokers and in non-smokers, although this did not reach statistical significance following adjustments for multiple testing. For comparisons between heavy smokers and non-smokers, statistically significant differences were found in the GCF concentrations of IL-1beta from deep bleeding sites only. Statistically significant differences were found in the IL-1ra concentrations for smokers vs. non-smokers for all categories of sites.

Adult↗

Prevalence of cardiovascular risk factors of the smokers and non-smokers in the city of Debrecen, Hungary.

The aim of our study was to compare the major cardiovascular disease (CVD) risk factors of smokers and non-smokers. Risk screening of CVD was estimated by a questionnaire, via interview. Random samples of 20 000 inhabitants of Debrecen, Hungary, aged 30-65 y, took part in the study. 19 922 questionnaires were considered appropriate for further evaluation. 32.2% of the participants (n=6410) were smokers, whose data were compared to those of the 68.8% of non-smokers (n=13 512). There were more male smokers than female (39.3% vs 27.7%), (P<0.001). 36.5% of males and 58.9% of females had not previously smoked regularly (P<0.001). 24.2% of males and only 13.3% of females were able to stop smoking (P<0.001). 8.7% of the participants smoked more than 20 cigarettes per day (14.8% of males, 5.0% of females), (P<0.001). Smokers were younger, with a mean age of 43.4 y vs 47.1 y for non-smokers (P<0.01). The ex-smokers and non-smokers had a higher body mass index than light, moderate and heavy smokers (26. 75+/-4.1 kg/m2 and 26.09+/-4.3 kg/m2 vs 24.87+/-3.9 kg/m2 and 24. 89+/-4.2 kg/m2 and 25.32+/-4.3 kg/m2, respectively), (P<0.001). The results of the last measured blood pressures did not differ between the two groups. 94.8% of smokers and 93.6% of non-smokers did not perform any regular leisure time exercises (P<0.01). 39.8% of smokers regularly ate fatty food, in comparison to 28.0% of non-smokers (P<0.001). 30.6% of smokers vs 28.6% of non-smokers were factory workers while 69.4% of smokers vs 71.4% of non-smokers did sedentary jobs (P<0.001). 2.3% of smokers vs 0.9% of non-smokers admitted regular consumption of alcohol (P<0.001). Amongst the parents and brothers/sisters of smokers the prevalence of heart attack was higher 19.7% vs 18.7%, than for those of non-smokers (P<0. 05). We observed an accumulation of cardiovascular risk factors in the case of smokers, which indicates the higher susceptibility of smokers to CVD.

Adult↗

Results of limited initial periodontal therapy in smokers and non-smokers.

Eighty-seven adult patients (54 non-smokers and 33 smokers) with moderate to advanced periodontitis were treated with 1-hour full-mouth subgingival scaling and root planing, with no maintenance recalls, during this 9-month study. Clinical parameters assessed at target sites included probing depth, clinical attachment level, bleeding on probing, gingival index, and plaque index. Data were collected at baseline, and 3, 6, and 9 months. Baseline probing depth for non-smokers was 5.46 +/- .46 mm and for smokers 5.70 +/- 0.66 mm. Data analysis (t test) revealed that both non-smokers and smokers had a statistically significant decrease (P < 0.05) in probing depth at 3 months which was maintained throughout the study. At 9 months non-smokers maintained a mean decrease in probing depth of 0.60 mm and smokers a mean decrease of 0.65 mm. Both smokers and non-smokers displayed a significant gain (P < 0.05) in clinical attachment level after initial therapy when compared to baseline readings. At 9 months the mean gain in clinical attachment level for non-smokers was 0.47 mm and 0.59 mm for smokers. Plaque index scores remained consistent for smokers and non-smokers for the duration of the study. The gingival index at baseline was significantly (P < 0.05) lower in smokers (1.32 +/- 0.45) than non-smokers (1.45 +/- 0.40). By 9 months only the gingival index of non-smokers decreased significantly compared to baseline (1.26 +/- 0.37). Bleeding on probing was a prerequisite for target sites at baseline. At 9 months both smokers (0.67 +/- 0.39) and non-smokers (0.78 +/- 0.30) had a significant decrease in bleeding on probing compared to baseline. At 9 months there were no significant differences between smokers and non-smokers comparing probing depth, clinical attachment level, plaque index, bleeding on probing, and gingival index. The data have shown that smokers and non-smokers responded similarly after 9 months to the limited amount of initial therapy provided.

Adult↗

Complications of postmastectomy breast reconstructions in smokers, ex-smokers, and nonsmokers.

Smoking results in impaired wound healing and poor surgical results. In this retrospective study, we compared outcomes in 155 smokers, 76 ex-smokers, and 517 nonsmokers who received postmastectomy breast reconstructions during a 10-year period. Ex-smokers were defined as those who had quit smoking at least 3 weeks before surgery. Transverse rectus abdominis musculocutaneous (TRAM) flap surgery was performed significantly less often in smokers (24.5 percent) than in ex-smokers (30.3 percent) or nonsmokers (39.1 percent) (p < 0.001). Tissue expansion followed by implant was performed in 112 smokers (72.3 percent), 50 (65.8 percent) ex-smokers, and 304 nonsmokers (58.8 percent) (p = 0.002). The overall complication rate in smokers was 39.4 percent, compared with 25 percent in ex-smokers and 25.9 percent in nonsmokers, which is statistically significant (p = 0.002). Mastectomy flap necrosis developed in 12 smokers (7.7 percent), 2 ex-smokers (2.6 percent), and 8 nonsmokers (1.5 percent) (p < 0.001). Among patients receiving TR4AM flaps, fat necrosis developed in 10 smokers (26.3 percent), 2 ex-smokers (8.7 percent), and 17 nonsmokers (8.4 percent). Abdominal wall necrosis was more common in smokers (7.9 percent) than in ex-smokers (4.3 percent) or nonsmokers (1.0 percent). In this large series, tissue expansion was performed more often in smokers than was autogenous reconstruction. Complications were significantly more frequent in smokers. Mastectomy flap necrosis was significantly more frequent in smokers, regardless of the type of reconstruction. Breast reconstruction should be done with caution in smokers. Ex-smokers had complication rates similar to those of nonsmokers. Smokers undergoing reconstruction should be strongly urged to stop smoking at least 3 weeks before their surgery.

Adult↗

[Basal energy expenditure in smokers and non-smokers with Crohn's disease].

BACKGROUND: Crohn's disease (CD) is associated with smoking and ulcerative colitis with non-smokers. The aim of study was to compare resting energy status of smokers is worse when compared with non-smokers. The aim of the study was to compare resting energy expenditure (REE) in smokers and non-smokers with CD. METHODS AND RESULTS: REE was measured in the morning in 18 fasting patients with CD (11 non-smokers, 7 smokers) using a metabolic cart (Deltatrac Datex) in a canopy system. In smokers REE was measured before and 30 minutes after having smoked one cigarette, in non-smokers before and 30 minutes after light physical activity. The results were expressed in per cent of the expected values calculated from Harris-Benedict formula (%HB). In CD REE was significantly higher in smokers when compared with non-smokers (mean +/- S.E.M.: 113.3 +/- 12.7 vs 103.1 +/- 10.2; p < 0.03; t-test). The increase of the second measurement was not significant both in smokers (115.4 +/- 9.4) and non-smokers (105.4 +/- 10.3). In 15 CD patients substrate utilization was also estimated from indirect calorimetry and urea production. There was a higher rate of glycides (mean +/- S.E.M.: 185.9 +/- 81.9 gm/min) and a lower rate of protein oxidation (22.7 +/- 15.5) in smokers when compared with non-smokers (glycides: 141.6 +/- 78.0, NS; proteins: 41.8 +/- 36.7, NS). There was no significant difference between smokers and non-smokers with CD in lipids oxidation (33.7 +/- 19.5 vs 32.9 +/- 22.3). CONCLUSIONS: A significantly higher REE was found in smokers with CD when compared with non-smokers with CD. Differences in substrate utilization were not significant. Our results support a recommendation for CD patients to be non-smokers.

Adult↗

Smoker and ex-smoker reactions to cigarettes claiming reduced risk.

CONTEXT: The tobacco industry is introducing modified tobacco products claiming to reduce the risk of smoking (potential reduced exposure products, PREPs). If PREPs are perceived as safe, they may deter smokers from quitting and encourage re-initiation by smokers who have quit. OBJECTIVE: To assess smokers' and ex-smokers' perceptions of PREPs and the impact of PREP claims on interest in quitting (among smokers) or in resuming smoking (ex-smokers). DESIGN: A random-digit-dialled survey of US smokers and ex-smokers. We used Eclipse, a modified PREP cigarette, as an exemplar PREP. During the survey, the interviewer read risk reduction claims made for Eclipse by its manufacturer, assessing smokers' interest in quitting before and after the exposure. PARTICIPANTS: 1000 current cigarette smokers and 499 ex-smokers (300 quit within the last two years), over 18 years old. MAIN OUTCOME MEASURES: Perception of risk reduction from Eclipse; interest in using Eclipse; smokers' interest in quitting was assessed using a stage of change approach (pre- and post-exposure to claims). RESULTS: 91% of smokers thought Eclipse was safer than regular cigarettes. 24% believed Eclipse was completely safe. 57.4% of smokers were interested in using Eclipse; interest was greatest among smokers who were contemplating quitting. Exposure to Eclipse's claims was followed by reduced interest in quitting. Among all ex-smokers, interest in Eclipse was 6.2%, but interest was 15.2% among young adults (18-25 years) who had stopped smoking within two years. CONCLUSIONS: There is substantial risk that smokers will overinterpret reduced risk claims made for modified tobacco products. PREPs appeal to smokers who are contemplating quitting and exposure to reduced risk product claims appears to reduce smokers' readiness to quit. PREPs also appealed to young adults who had recently stopped smoking. Thus, reduced risk tobacco product claims can undermine adult cessation and youth prevention, possibly resulting in increased harm even if the products are less toxic.

Adult↗

Bronchial reactivity to inhaled histamine and annual rate of decline in FEV1 in male smokers and ex-smokers.

We examined the relations between bronchial reactivity, baseline FEV1, and annual decline of height corrected FEV1 (delta FEV1/ht3) over 7.5 years in 227 men (117 smokers, 71 ex-smokers, and 39 non-smokers). Men with a clinical diagnosis of asthma or receiving bronchodilator treatment were excluded. Bronchial reactivity was determined as the provocation concentration (PC20) of inhaled histamine sufficient to reduce FEV1 by 20%; subjects were divided into reactors (PC20 less than or equal to 16 mg/ml) and non-reactors (PC20 greater than 16 mg/ml). Thirty per cent of smokers, 24% of ex-smokers, and 5% of non-smokers were reactors. When smokers who were reactors were compared with non-reactors, the reactors showed a lower baseline FEV1 as percentage predicted in 1981-2 (85% v 108%), and a faster delta FEV1/ht3 (14.1 v 9.2 ml/y/m3). Baseline FEV1 correlated with PC20 in both smokers (rs = 0.51) and ex-smokers (rs = 0.61), and all 15 subjects with an FEV1 under 80% of the predicted value were reactors. In ex-smokers delta FEV1/ht3 was similar in reactors and non-reactors (m 9.0 v 7.4 ml/y/m3), despite significant differences in baseline FEV1. When analysis was confined to men with a baseline FEV1 over 80% predicted, the prevalence of reactors was significantly increased among smokers and slightly increased among ex-smokers compared with non-smokers, though the mean FEV1 was higher in the non-smokers. Bronchial reactivity was not increased in smokers aged 35 years or less. In smokers delta FEV1/ht3 was faster in those with a personal history of allergy (usually allergic rhinitis), but was not related to a family history of allergic disease, total serum immunoglobulin E level, absolute blood eosinophil count, or skinprick test score. delta FEV1/ht3 was also faster in all subjects taking beta blocker drugs. Thus increased bronchial reactivity was associated with accelerated decline of FEV1 in smokers. Although the association could be a consequence of a lower lower baseline FEV1, a trend towards increased reactivity was found in smokers with normal baseline FEV1 and delta FEV1/ht3 was dissociated from increased reactivity in ex-smokers. These findings are compatible with the "Dutch hypothesis," but the association between allergic features and accelerated delta FEV1/ht3 was relatively weak, and increased reactivity may follow rather than precede the onset of smoking.

Bronchi↗