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PubMed1986

A double-blind randomized controlled trial of the effect of a low- versus a middle-tar cigarette on respiratory symptoms--a feasibility study.

A feasibility study of a double-blind, randomized controlled trial of the effect of a low-versus a middle-tar cigarette on respiratory symptoms is described. A smoking questionnaire was sent to 19,366 households. Returned questionnaires (64%) yielded 604 middle-tar cigarette smokers aged 20-44 years; 342 replied to a health warning stating that they did not want to or had failed to stop smoking and of these 183 volunteered for the trial. Thus about every 100 households originally mailed yielded one volunteer. Of the volunteers, 95 men were randomly allocated to be sold a middle-tar cigarette and 88 to be sold a low-tar cigarette of identical appearance. The cigarettes were sold at three different reduced prices and the men were asked to smoke them for five weeks. There was a 22% drop-out and this was unrelated to type of cigarette smoked. A reduction in price of 20% was sufficient incentive for volunteers to participate. Cigarette butts were collected weekly or fortnightly and urine samples were collected initially and after three and five weeks. Compliance with the trial cigarettes was good. The excretion of nicotine metabolites, number of cigarettes smoked and average butt weight for men allocated the low-tar cigarette was not significantly different from that of those allocated the middle-tar cigarette. This suggested that the former compensated for the 37% reduction in the nicotine yield of their cigarette by taking more frequent or deeper puffs from their cigarette. The implications of these results for a large-scale, randomized controlled trial are discussed.

Adult↗

PubMed2005

Effects of erdosteine on smoking-induced lipid peroxidation in healthy smokers.

AIM: Oxidative stress caused by smoking has been implicated in many pulmonary diseases. Smoking causes reductions in plasma nitrate plus nitrite (NOx) concentrations and increases in plasma malondialdehyde (MDA) concentrations, which indicate oxidative stress and lipid peroxidation, respectively. In this study, we investigated the acute effects of smoking a single cigarette on the plasma concentrations of NOx and thiobarbituric acid reactive substances (TBARS) including MDA, and whether administration of erdosteine, a mucolytic and antioxidant agent, affects these parameters. METHODS: Thirty healthy smokers were included in the study. Subjects smoked a single cigarette in 10 minutes on the study day. For analysis of NOx, TBARS and cotinine, blood was drawn from each subject before and 5 and 30 minutes after smoking. The subjects were then randomly divided into two groups, one receiving placebo and the other erdosteine suspension 175mg/5mL twice daily for 1 month. After this treatment period, the same study protocol was carried out. Two subjects in the placebo and five subjects in the study group were excluded because of noncompliance. RESULTS: Twenty-three (14 female, 9 male) subjects completed the study. Their mean age was 32 +/- 8 years and their smoking history was 14 +/- 9 pack-years. Baseline NOx, TBARS and cotinine concentrations were similar between the groups. NOx concentrations decreased significantly after smoke exposure. At the end of the treatment period there were no significant differences in NOx, TBARS or cotinine concentrations between the groups. The concentration of TBARS after smoking decreased significantly in the erdosteine-treated group (at 5 minutes: 2.8 +/- 0.5 micromol/L before treatment and 2.3 +/- 0.3 micromol/L after treatment, p < 0.05; at 30 minutes: 2.8 +/- 0.5 micromol/L before treatment and 1.8 +/- 0.7 micromol/L after treatment, p < 0.05). Smoking history was significantly correlated with cotinine concentrations. CONCLUSION: Acute smoke exposure decreased plasma NOx concentrations in healthy smokers, and this was not changed with erdosteine treatment. However, significant decreases were noted in TBARS concentrations after smoke exposure in the group that received erdosteine, suggesting that short-term erdosteine administration might help prevent smoking-induced lipid peroxidation.

Adult↗

PubMed2006

Multiple risk factor interventions for primary prevention of coronary heart disease.

BACKGROUND: Primary prevention programmes in many countries attempt to reduce mortality and morbidity due to coronary heart disease (CHD) through risk factor modification. It is widely believed that multiple risk factor intervention using counselling and educational methods is efficacious and cost-effective and should be expanded. Recent trials examining risk factor changes have cast considerable doubt on the effectiveness of these multiple risk factor interventions. OBJECTIVES: To assess the effects of multiple risk factor intervention for reducing cardiovascular risk factors, total mortality, and mortality from CHD among adults without clinical evidence of established cardiovascular disease. SEARCH STRATEGY: MEDLINE was searched for the original review to 1995. This was updated by searching the Cochrane Central Register of Controlled Trials on The Cochrane Library Issue 3 2001, MEDLINE (2000 to September 2001) and EMBASE (1998 to September 2001). SELECTION CRITERIA: Intervention studies using counselling or education to modify more than one cardiovascular risk factor in adults from general populations, occupational groups, or high risk groups. Trials of less than 6 months duration were excluded. DATA COLLECTION AND ANALYSIS: Data were extracted by two reviewers independently. Investigators were contacted to obtain missing information. MAIN RESULTS: A total of 39 trials were found of which ten reported clinical event data. In the ten trials with clinical event end-points, the pooled odds ratios for total and CHD mortality were 0.96 (95% confidence intervals (CI) 0.92 to 1.01) and 0.96 (95% CI 0.89 to 1.04) respectively. Net changes in systolic and diastolic blood pressure, and blood cholesterol were (weighted mean differences) -3.6 mmHg (95% CI -3.9 to -3.3 mmHg), -2.8 mmHg (95% CI -2.9 to -2.6 mmHg) and -0.07 mMol/l (95% CI -0.8 to -0.06 mMol/l) respectively. Odds of reduction in smoking prevalence was 20% (95% CI 8% to 31%). Statistical heterogeneity between the studies with respect to mortality and risk factor changes was due to trials focusing on hypertensive participants and those using considerable amounts of drug treatment. AUTHORS' CONCLUSIONS: The pooled effects suggest multiple risk factor intervention has no effect on mortality. However, a small, but potentially important, benefit of treatment (about a 10% reduction in CHD mortality) may have been missed. Risk factor changes were relatively modest, were related to the amount of pharmacological treatment used, and in some cases may have been over-estimated because of regression to the mean effects, lack of intention to treat analyses, habituation to blood pressure measurement, and use of self-reports of smoking. Interventions using personal or family counselling and education with or without pharmacological treatments appear to be more effective at achieving risk factor reduction and consequent reductions in mortality in high risk hypertensive populations. The evidence suggests that such interventions have limited utility in the general population.

Coronary Disease↗

PubMed1977

Smoking habits among Norwegian doctors 1974.

In the spring of 1974 a representative sample (N = 1200) of all doctors in Norway (6 000) received a mailed questionnaire regarding past and present smoking habits. Close to 95% responded. Among late responders there was a disproportionately high number of smokers. As compared with the general population, both male and female doctors constitute a small proportion of daily smokers and a large proportion of exsmokers. The greatest contrasts are observed in the younger age groups. The percentage of daily smokers in this crossectional study on the medical profession is approximately 50% lower than that found in the 1952--53 study on Norwegian doctors. There is also a shift away from cigarette smoking toward the use of pipe and cigars, which is not found in the general population. Answers to questions regarding reasons for quitting as well as certain attitudinal indicators show that the doctors' reduction in smoking is related to their professional involvement and high level of knowledge concerning the health consequences of smoking.

Adult↗

PubMedDate not supplied

[Effect of smoking on lipoprotein metabolism].

INTRODUCTION: Recent aspects concerning effects of smoking on lipoprotein metabolism are presented as well as their harmful effects on blood vessels. It has been proved that smoking stimulates oxidation of LDL particles, producing a significant increase of triglycerides and a decrease of HDL-cholesterol, mostly due to HDL, subfraction diminution. LIPID AND LIPOPROTEIN DISORDERS: Changes of other lipid and lipoprotein parameters are not significant and may even not be found in certain investigations. They are independent of age, body mass, physical activity, alcohol consumption and hormonal status in women; however, they are affected by inappropriate diet. A complete and very fast reversibility of changes after smoking cessation is significant and is important while taking blood for laboratory analyses and interpretation of results. Concerning atherosclerosis, increased oxidation in LDL particles is of great significance. It is established that in vitro exposition of LDL particles to the cigarette smoke induces their increased oxidation and in smokers an increased antibody level of oxidased LDL particles is found. CONCLUSION: A number of arguments speak in favor to the opinion that the unique mechanism by which smoking affects lipoprotein metabolism is its connection to the insulin resistance phenomenon.

Humans↗

PubMed1994

Bladder and kidney cancers.

The major factor contributing to the increase in incidence of both renal and urothelial cancers has been improved detection rates. To a considerable extent, this accounts for the difference between the trends in incidence and mortality since, on the whole, the efficacy of treatment has improved only slowly. In the case of renal parenchymal cancer, the true burden of disease is rising almost everywhere, probably reflecting changes in standard of living, perhaps chiefly diet, although there will be some contribution from smoking. Where the increase in bladder cancer is not artefactual, it can be attributed in large part to smoking and perhaps to increasing industrial exposure in some localities. Trends in incidence and, to a greater degree, mortality for urothelial cancer are likely to improve substantially with implementation of policies of prevention (reduction in smoking, improvements in industrial hygiene), earlier detection (eg with monoclonal antibodies) and treatment (immunotherapy). No such optimism can be held with respect to renal parenchymal cancer, which is set to become one of the major cancers of affluent societies unless its aetiology becomes known and can be addressed.

Adult↗

PubMed1997

Modeling the effects of combined behavioral and pharmacological treatment on cigarette smoking: behavioral-economic analyses.

Effects of different response requirements, response-independent cigarette puffs, and an alternative nondrug reinforcer on cigarette smoking were assessed in 2 experiments. The response requirement to obtain 2 puffs on a cigarette was manipulated while various numbers of response-independent puffs were provided (0, 6, or 12 in Experiment 1; 0 or 12 in Experiment 2). In Experiment 2, effects of response-dependent money ($0.25) on smoking were assessed within subjects. Response-dependent puff consumption decreased as price increased and as the number of response-independent puffs increased. Concurrently available money also decreased response-dependent smoking. The largest decrease in smoking occurred when puffs were at the highest price and when response-independent puffs and response-dependent money were both concurrently available. Findings suggest that combined pharmacological and behavioral interventions produce the greatest reductions in smoking.

Adult↗

PubMed2003

Tobacco cessation in primary care: maximizing intervention strategies.

The most effective preventive intervention that a clinician can provide for tobacco-using patients against heart disease, cancer, cerebrovascular disease and chronic obstructive pulmonary disease is an empathic, personalized smoking cessation intervention program with extended assistance and follow-up. The goal of the intervention must be complete smoking cessation. Reduction provides no direct health benefits to the individual smoker. Interventions are readily available, but underutilized, in part due to lack of clinician training and organizational support. The present article summarizes the current guidelines for smoking cessation interventions as a framework from which to start. The guidelines incorporate the Transtheoretical Model of patient behavioral change and the "Five A's": Ask, Advise, Assess, Assist and Arrange. Pharmacotherapeutic tools, including nicotine replacement therapies (nicotine gums, patches, nasal sprays, inhalers and new therapies) and non-nicotine therapies (bupropion, clonidine, nortriptyline and other antidepressants and anxiolytics) are considered. Adherence validation methods, new approaches to tobacco and addiction treatment that appear in the recent research literature are reviewed. Beyond this framework, specific categories of tobacco users (including smokeless tobacco users), cultural and ethnic minorities, adolescents using snuff and bidis, women, Medicaid recipients, and users of multiple forms of tobacco require special consideration. With this framework and the modifications that may be required for specific categories of patients, practicing clinicians can incorporate into daily practice a successful tobacco cessation intervention program with quit rates approaching 20%.

Humans↗

PubMed2002

Smoking among adolescents: relation to school success, socioeconomic status nutrition and self-esteem.

OBJECTIVE: Smoking is a worldwide health problem. This study was designed to evaluate the current status and to examine some potential factors affecting smoking among adolescents. DESIGN: Descriptive, cross-sectional study. SETTING: Community based study. SUBJECTS: Of all middle and high school students in Edirne, Turkey, 883 (6.83%) were randomly sampled. Mean age of the subjects was 15.0 +/- 1.8 years. METHOD: A self-applied questionnaire was used to collect demographic data, smoking status, school success, nutritional behaviour and self-esteem. The influence of different factors on smoking was evaluated with a logistic regression model. RESULTS: There were 89 active smokers (11.1%) with the critical age of 15 years for smoking commitment. 609 students (71.9%) were exposed to environmental tobacco smoke. Nutritional behaviour rich in vegetables (OR = 0.813), high school success (OR = 0.807), longer time reserved for homework (OR = 0.718) and eating breakfast (OR= 0.353) were significantly associated with a lower smoking rate. Having a mother, who smoked (OR = 2.155), increasing age (OR = 1.704), increasing number of siblings (OR = 1.351) and eating fast food (OR = 1.150) were associated with significantly higher smoking rates. CONCLUSION: An educational programme aimed at changing behaviour and attitude to tobacco smoking and including nutritional counselling with high emphasis on the transition age from early to late adolescence may be a successful primary prevention. In addition projects designed to improve school performance may lead to a reduction in smoking rates while providing an investment in the future of the teenagers.

Achievement↗

PubMed2000

The Nitrite/alpha crystallin reaction: a possible mechanism in lens matrix damage.

Recent work has explored the potential deleterious role that nitric oxide (NO) and its derivatives may have in human disease. The many by-products of NO include nitrite ion, which accumulates in the anterior chamber during ocular inflammation and can be derived from cigarette smoking. Cigarette smoking has been strongly linked to nuclear cataract formation, although the mechanism remains unknown. We have previously observed that nitrite reactions with the matrix proteins elastin and collagen produce damaging effects that mimic those observed in age- and smoking-related illnesses. In the present study we report on the reaction of nitrite with alpha crystallin, the major lens matrix protein. Incubations at neutral pH and body temperature of nitrite with alpha crystallin resulted in protein modifications indicative of oxidative damage and similar to changes seen in the aging lens as well as cataracts. These include increased fluorescence, yellowing and protein cross-linking. L-kynurenine, a tryptophan derivative, was identified as a reaction product. L-kynurenine was also formed from the reaction of nitrite with free tryptophan. Thus, this non-enzymatic nitration of alpha crystallin provides a novel mechanism by which lens proteins may be damaged in vivo. Since human exposure to nitrite is increased by cigarette smoking, this reaction could provide an explanation for the association between nuclear cataracts and smoking.

Aging↗

PubMed2002

Toxicologic evaluation of humectants added to cigarette tobacco: 13-week smoke inhalation study of glycerin and propylene glycol in Fischer 344 rats.

Glycerin (CAS no. 56-81-5) and propylene glycol (CAS no. 57-55-6) are commonly used as humectant ingredients in manufactured cigarettes to control and maintain the moisture content of the cut tobacco filler. The potential of these added humectants to affect the toxicity of cigarette smoke was investigated in a subchronic nose-only smoke inhalation study in rats. Filtered test cigarettes were prepared from an American-style tobacco blend containing either glycerin added at 5.1% w/w tobacco, propylene glycol at 2.2% w/w tobacco, or combinations of these humectants totaling 2.3%, 3.9%, and 7.2% w/w tobacco. Other groups of animals were exposed similarly to the smoke of reference cigarettes without added humectants, or to filtered air (sham control). Smoke exposures were conducted for 1 h/day, 5 days/wk for 13 wk, at target smoke particulate concentrations of 350 mg/m(3). All smoke-exposed groups had equivalent increases in blood carboxyhemoglobin, serum nicotine, and serum cotinine relative to the air controls. Smoke-associated reductions in body weights and occasional increases in heart and lung weights were generally similar among the various exposure conditions at necropsy. Increases in serum alkaline phosphatase and decreases in serum glucose and cholesterol were observed among smoke-exposed females relative to air controls. However, no significant differences in these parameters were evident between the humectant-containing and reference cigarette smoke exposure groups. Assessments of respiration conducted after 3, 6, 9, and 12 wk of smoke exposure indicated an initial smoke-related but not humectant-related decrease in respiratory rate, tidal volume, and minute volume during the first 20 min of each smoke exposure. Respiratory-tract histopathology was consistent across sexes and smoke groups, comprising (1) diffuse and focal alveolar pigmented macrophages and chronic interstitial inflammation in the lung, (2) laryngeal epithelial hyperplasia, squamous metaplasia, and scab formation, and (3) epithelial hyperplasia in the anterior nose. Smoke-related histopathology resolved substantially during a 6-wk postexposure recovery period. Addition of the tested humectants to cigarettes, singly or in combination, had no meaningful effect on the site, occurrence, or severity of respiratory-tract changes or on the measured indices of pulmonary function. It was concluded that the addition of glycerin and propylene glycol to cigarettes does not significantly affect the biological activity of inhaled cigarette smoke in this rat model.

Administration, Inhalation↗

PubMed1987

Effect of anti-smoking health education on infant size at birth: a randomized controlled trial.

The effects of anti-smoking health education during pregnancy on smoking behaviour and the subsequent infant's size at birth were investigated in a controlled trial. It was found that the planned educational intervention was incompletely carried out and was given more effectively to primigravidae in whom subsequent reduction of smoking was more evident. The effects of educative intervention on size at birth were therefore analysed for first and later pregnancies separately. The differences in birthweight and length between the intervention and control groups were concentrated almost entirely among the first born infants who were 68 g heavier and 0.75 cm longer in the intervention group than the first born infants in the control group.

Anthropometry↗

PubMed2002

Recent trends in smoking prevalence in South Africa--some evidence from AMPS data.

OBJECTIVE: To estimate trends in smoking prevalence among different demographic and income segments for the period 1993-2000. METHODOLOGY: Annual data were obtained from a commercially generated database focusing on product usage. Using regression techniques, trends in smoking prevalence were estimated. RESULTS: Since 1993 aggregate cigarette consumption has decreased by 26%. Smoking prevalence has decreased from 32% to 27% of the adult population. This is ascribed mainly to the sharp increase in cigarette prices. Sixty per cent of the decrease in per capita cigarette consumption is explained by a reduction in average consumption of smokers. The other 40% is explained by a reduction in smoking prevalence. Smoking prevalence has been decreasing for most demographic and socio-economic groups. The most significant decreases have been recorded for males, blacks, young adults, and low-income households. Groups that have not experienced significant decreases in smoking prevalence include coloureds, whites, females, and high-income households. CONCLUSION: Rapidly increasing excise taxes are a powerful policy tool in reducing cigarette consumption. Because poor people spend a larger proportion of their income on cigarettes, their relative tax burden is higher than the more affluent sections of society. Cigarette excise taxes are therefore regressive. However, since the poor tend to reduce their consumption by a greater percentage than the rich in response to price increases, excise increases are likely to reduce the regressiveness of the tax. Nevertheless, in view of the low quitting rates, a strong case exists for the government to subsidize cessation and nicotine replacement therapies, especially among the poor.

Adolescent↗

PubMed1990

Beneficial effects of treatment of nicotine dependence during an inpatient substance abuse treatment program.

The Minneapolis Department of Veterans Affairs Medical Center began an intervention for tobacco use in its inpatient substance dependency treatment program on June 19, 1988, including an institutional smoke-free policy and a smoking cessation program. Sequential substance-dependent patients admitted before institution of the policy (n = 455) were compared with patients admitted after institution of the policy (n = 457). Patients completed self-administered questionnaires regarding smoking practices and attitudes. Seventy-six percent of patients were current cigarette smokers. Fifty-eight percent of patients after institution of the policy described themselves as "not smoking regularly," compared with 19% of patients admitted before the institution of the policy. Similar proportions of patients admitted before and after the institution of the policy believed that quitting smoking would threaten recovery. Forty-one percent of patients hospitalized after institution of the policy abstained from smoking for more than 1 week during their hospital stay. Rates of early termination of treatment did not change. We conclude that concurrent intervention for nicotine addiction during inpatient treatment of substance dependence is associated with a temporary reduction in smoking and increased motivation to quit smoking.

Adult↗

PubMed1984

Who quits smoking in a behavioral treatment program?

Data from a smoking cessation program were analyzed to identify the variables that best predicted posttreatment abstinence. Nonsmoking immediately following treatment was predicted by lower daily pretreatment intake of nicotine and total particulate matter (TPM), as well as higher score on the "handling" scale of the "Why Do You Smoke" scale. Abstinence at any time in the 6 months following treatment was also predicted by lower pretreatment nicotine and TPM intake; other predictors were lower scores on the "craving" scale, greater number of weeks spent participating in the program, citing reasons for wanting to quit smoking other than to overcome an addiction, and lower self-rated craving for cigarettes. Abstinence was not predicted by subjects' adherence to the treatment rules calling for changing the times, occasions and feelings that are associated with the heaviest smoking. Daily cigarette consumption dropped during treatment at similar rates for the smokers who would eventually be abstinent and those who would not. These results replicate the finding that a behavioral self-control program can bring about a reduction in smoking in many smokers, though relatively few actually quit smoking. Also, smokers who find the manipulations involved in smoking to be rewarding are more likely to be abstinent, at least temporarily, following a behaviorally oriented program than are smokers who are most rewarded by the self-administration of nicotine. Smoking cessation programs might benefit by tailoring treatment to such pretreatment subject characteristics.

Attitude↗

PubMed1991

Screening for coronary risk factors in occupational health practice.

Screening for coronary risk factors (blood cholesterol greater than 5.2 mmol/l; body mass index greater than 25; blood pressure greater than 140/90 and positive smoking history) using nurse administered voluntary health assessments was studied in occupational health practice. A high employee participation rate (80.9 per cent) was achieved with few employees declining to attend, confirming the advantages of workplace based screening. Hypercholesterolaemia, overweight and smoking were the most prevalent risk factors. Men had higher rates than women as judged by independent or concomitant risk factor rates; 56.5 per cent of men were over ideal body weight, 40 per cent of men smoked, 35.7 per cent of men had two risk factors and 2 per cent of men had four risk factors. Blood cholesterol and blood pressure were shown to increase with increasing body weight. It is suggested that body weight reduction and smoking cessation are the preferred intervention strategies in occupational health practice.

Adolescent↗

PubMed1998

Smoking correlates with flow-mediated brachial artery vasoactivity but not cold pressor vasoactivity in men with coronary artery disease.

Impaired endothelial function is observed as altered vasomotion in both the peripheral and coronary circulation in the presence of cardiovascular risk factors and early atherogenesis. An improvement in endothelium-dependent vasoactivity has been reported with both cholesterol reduction and smoking cessation. This study was performed to determine whether smoking status in coronary artery disease (CAD) effects both flow-mediated and cold pressor vasoactivity. We studied 25 men (ages 30-59), 12 smokers and 13 nonsmokers with angiographically documented coronary artery disease and cardiac risk factors who were grouped as smokers and nonsmokers. Using 7.5 MHz ultrasound, we measured brachial artery diameter and Doppler flow velocity at baseline, following 5 mins of ipsilateral blood pressure cuff occlusion and release (flow-mediated), during contralateral ice water hand immersion (cold pressor test) and after sublinqual nitroglycerin administration (an endothelium-independent vasodilator). Flow-mediated percent diameter change was significantly less in the smokers than nonsmokers (1.9 +/- 5.7% vs 11.4 +/- 7.2%, p < 0.001). Both smokers and nonsmokers responded similarly to the cold pressor test (-3.9 +/- 2.3 vs -1.2 +/- 0.2%) and nitroglycerin (15.1 +/- 7.6 vs 17.5 +/- 8.3%). Cholesterol level did not appear to be an independent determinant of flow-mediated vasoactivity when smoking status was taken into account. Flow-mediated vasoactivity is associated with smoking status in the presence of coronary artery disease but cold pressor induced vasoactivity is not.

Adult↗

PubMed2005

Curbing adolescent smoking: a review of the effectiveness of various policies.

Tobacco-related mortality is one of the biggest killers in American medicine. Evidence suggests that if adolescents can be kept tobacco-free, most will never start using tobacco. Therefore, tobacco control policies directed at the youth population could provide an effective method for sustaining long-term reductions in smoking in all segments of the population. Many forms of tobacco control policies have been implemented including restrictive laws, public campaigns, and taxation duties; there has been disagreement over which is most effective. We investigate the efficacy of various methods of tobacco control in youth and present a review of the published evidence. Econometric data for both youth access restrictions and environmental tobacco smoke restrictions afford ambiguous results. Results vary in a continuum from a moderate negative effect toward, ironically, a marginal positive effect on smoking. While information dissemination policies may be somewhat effective on the onset, they are limited in their effect and eventually diminish over time. We conclude that increases in price affect teen smoking to a great degree. Most estimates show that for a 10 percent increase in prices, which could be implemented by a tax per pack, a 15 percent decrease in cigarettes consumed could be accomplished. Taxation policies are an effective means of preventative medicine.

Adolescent↗