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PubMed1995

Cigarette smoking during pregnancy.

OBJECTIVES: To determine: 1. the prevalence of regular smoking in the latter half of pregnancy in a sample of Canadian prenatal patients; 2. the psycho-social and demographic characteristics that differentiate smoking from nonsmoking patients; 3. the characteristics that differentiate prenatal patients who smoke more than 10 cigarettes per day from those who smoke 1 to 10 cigarettes per day; and 4. the psychiatric morbidities or psychological attitudes associated with smoking in pregnancy. METHODS: Consecutive consenting women 20 or more weeks pregnant were given, at a prenatal clinic, the General Health Questionnaire (GHQ), the Fetal Health Locus of Control (FHLC), and a study questionnaire to complete. RESULTS: Five-hundred and forty-five women completed the questionnaires. Eighty-nine (16.3%) women reported regular daily cigarette smoking in the second half of pregnancy, while 43 (7.9%) smoked more than 10 cigarettes per day. Women who smoked were more likely than nonsmokers to be under 21, born in Canada, have only elementary education, be unemployed and unmarried, eat unhealthy diets, drink alcohol, use nonprescription and illicit drugs, have unplanned pregnancies, histories of emotional and physical problems, and have suffered physical abuse before and during pregnancy. Smokers were more likely than nonsmokers to meet case status on the GHQ and on the FHLC to believe "chance" and less likely to believe that "internal control" or "powerful others" affected the health of their fetuses. "Social disorganization", "health risks", and "poor health" factors accounted for 83.1% of the total variance. CONCLUSIONS: Women who smoke in pregnancy have a higher rate than nonsmokers of other health risk behaviours, social disadvantage, and emotional disturbance. Psychiatrists can play an important role in identifying and treating emotional and psychiatric morbidity in women of reproductive age to facilitate a reduction in smoking rates in this high-risk population.

Adolescent↗
PubMed2003

[The prevalence of and attitudes toward smoking among physicians in Azuay, Ecuador].

OBJECTIVES: To learn the prevalence of smoking among physicians in the province of Azuay, Ecuador, as well as their attitudes toward the habit. METHODS: This descriptive cross-sectional study was conducted using a survey that was based on models used in previous research. The survey consisted of 14 questions on the physicians' sociodemographic characteristics, issues related to the use of tobacco, and the physicians' attitudes toward smoking among their patients. The survey was delivered to 884 physicians and answered by 687 of them (77.7%). The results were entered into an electronic database, and multivariate analysis was carried out with the SPSS version 7.5 software package. Subgroups were compared using stratified analysis. Even though the study was descriptive, parametric statistical tests were applied with the quantitative variables, and Pearson's chi-square test was used to compare associations between discrete variables. A P level < 0.05 was considered statistically significant. RESULTS: Of the 687 physicians who responded to the survey, 8 of them did not answer all the questions and so were excluded from the sample. Of the remaining 679, 509 of them (75%) were men and 170 (25%) were women. Their average age was 43, and the prevalence of smoking for the group overall was 32.4%. The large majority of the smokers were between 36 and 55 years old. The male physician smokers smoked more cigarettes per day than did the female physician smokers (P < 0.05). Of the physician smokers, 68% of the men had been smoking for more than 10 years, but this was true for only 46% of the women. In terms of when the smokers began smoking, 47.1% of the men started when they were between 16 and 20 years old, while the single largest group of women smokers (40.5%) began when they were between 21 and 25 years old. Of the physicians who smoked, 60% of them said they did so in the workplace, and 67.6% of them said they had tried to quit smoking at some point. The physician smokers were less critical of smoking than were the physician nonsmokers, and the smokers also less frequently advised their patients to stop smoking (53.2% vs. 71.6%; P < 0.01). CONCLUSIONS: The prevalence of smoking among the physicians in the province of Azuay, Ecuador, is one of the highest among physicians in Latin America, and it is also similar to the overall rate for adults in Ecuador. These patterns make it difficult to expect a reduction in smoking in the province. There is an urgent need to implement preventive and therapeutic actions to control this scourge.

Adult↗
PubMed2004

Guideline for the management of chronic obstructive pulmonary disease (COPD): 2004 revision.

OBJECTIVE: To revise the South African Guideline for the Management of Chronic Obstructive Pulmonary Disease (COPD) in the light of new insights into the disease and the value of new treatment approaches and drugs. New aspects considered include: A growing awareness of the impact of COPD in South Africa, and the urgent need for prevention strategies. The role of concurrent exposures to domestic and occupational atmospheric pollution, and previous lung infections including tuberculosis. The need to consider as goals of treatment both prevention of exacerbations and improvement of quality of life (health status) of patients with COPD. The development of both long-acting beta2-agonist and anticholinergic drugs for use in COPD. Emerging evidence on a limited role for inhaled corticosteroids in the treatment of COPD. RECOMMENDATIONS: These include primary and secondary prevention; early diagnosis; staging of severity; assessment of reversibility with bronchodilator and, in some, responsiveness to corticosteroids; use of bronchodilators and other forms of treatment; rehabilitation; and treatment of complications. Advice is provided on the management of acute exacerbations, and the approach to air travel, prescribing long-term oxygen, and lung surgery including lung volume reduction surgery. Prevention, both primary and secondary, remains the most cost-effective measure in the management of COPD, and deserves more emphasis, particularly on the part of health care professionals. Primary prevention involves reducing public exposure to cigarette and other forms of smoke, and reduction of atmospheric pollution, and secondary prevention limits exposure and resultant progression in those with established disease. Spirometry is essential for the diagnosis of COPD and in staging severity. In addition, a new classification of severity that considers other indices of functional impairment is provided. Treatment involves a progression from 'as-needed' bronchodilators, through the addition of other more effective bronchodilators, usually in combination, in more severe stages. The importance of assessing potential reversibility in every patient with persistent symptoms, and of the limited role of oral and inhaled corticosteroids (ICS), is emphasised. These approaches also reduce exacerbations and may result in cost savings and improved prognosis. A practical low-cost approach to rehabilitation is proposed. OPTIONS: Treatment recommendations are based on the following: the recommendations of the Global Obstructive Lung Disease (GOLD) initiative, which provides an evidence-based comprehensive and up-to-date review of treatment options; independent evaluation of the level of evidence in support of some of the new treatment trends; and consideration of factors that influence COPD management in South Africa, including lung co-morbidity and drug availability and cost. OUTCOMES: The use of bronchodilators is driven by the presence of symptoms, but regular assessment of benefit, based on objective criteria, is essential. Several forms of treatment reduce exacerbations, the most effective of these is smoking cessation. EVIDENCE: Working group of clinicians and clinical researchers following detailed literature review, particularly of studies performed in South Africa, and the GOLD guidelines. BENEFITS, HARMS AND COSTS: The guideline pays particular attention to cost-effectiveness in South Africa, and promotes the initial use of less costly options. It rejects empirical use of corticosteroids both oral and inhaled, and promotes smoking cessation, and selection of treatment based on objective evidence of benefit. It also rejects a nihilistic or punitive approach, even in those who are unable to break the smoking addiction. VALIDATION: The COPD Working Group comprised experienced pulmonologists representing all university departments in South Africa and some from private practice. All contributed to the development of the previous version of the South African guideline, and attend international meetings. One (JRJ) represents South Africa on the GOLD Guideline Executive. GUIDELINE SPONSOR: The meeting of the Working Group of the South African Thoracic Society was sponsored by an unrestricted educational grant from Boehringer Ingelheim (South Africa) (Pty) Ltd.

Bronchodilator Agents↗
PubMed2005

The role of public policies in reducing smoking and deaths caused by smoking in Vietnam: results from the Vietnam tobacco policy simulation model.

A simulation model is developed for Vietnam to project smoking prevalence and associated premature mortality. The model examines independently and as a package the effects of five types of tobacco control policies: tax increases, clean air laws, mass media campaigns, advertising bans, and youth access policies. Predictions suggest that the largest reductions in smoking rates will result from implementing a comprehensive tobacco control policy package. Significant inroads may be achieved through tax increases. A media campaign along with programs to publicize and enforce clean air laws, advertising bans and youth access laws would further reduce smoking rates. Tobacco control policies have the potential to make large dents in smoking rates, which in turn could lead to many lives saved. In the absence of these measures, deaths from smoking will increase. The model also helps to identify information gaps pertinent both to modeling and policy-making.

Adolescent↗
PubMed2005

Predictors of success in smoking cessation among hospitalized patients.

OBJECTIVE: To determine the predictors of continued smoking abstinence in patients receiving smoking cessation intervention during and following hospital admission. METHODOLOGY: A prospective cohort study was conducted in a university-affiliated hospital. A total of 248 smokers admitted with primary cardiac and respiratory conditions received verbal advice (lasting about 1 h) and standard booklets on smoking cessation from a dedicated nurse counsellor. After discharge, participants received follow-up telephone counselling calls every 2 weeks from the same smoking counsellor. The main outcome measure was continued abstinence at 2 months after hospital discharge, as determined by self-reporting and carbon monoxide breath testing. The following groups of covariates were analysed to determine the possible factors associated with smoking abstinence: demographics, smoking history, readiness to quit, and medical history. RESULTS: At 2 months post-discharge, 108 (43.5%) patients remained abstinent. Low nicotine dependence score (odds ratio, 2.30; 95% CI, 1.25-4.26; P = 0.008), decision to quit by sudden cessation as compared to reduction of smoking (odds ratio, 7.19; 95% CI, 1.56-33.06; P = 0.011), and initial hospitalization for their medical condition (odds ratio, 6.37; 95% CI, 1.33-30.44; P = 0.020) were the main independent predictors for positive outcome. CONCLUSION: Among this cohort of hospitalized patients receiving smoking cessation intervention, low dependence on tobacco, motivation to quit by sudden cessation, and initial hospitalization were the main independent predictors of smoking abstinence after discharge from hospital.

Age of Onset↗
PubMed2004

Recent trends in home and work smoking bans.

OBJECTIVES: Home and work smoking bans at the national and state level in the USA, and their relation to smoking prevalence and to tobacco control policies, are examined. DATA: The Current Population Survey's 1992/93 and 1998/99 tobacco use supplement surveys are the primary data source, supplemented with information on state level tobacco control policies. METHODS: The national and state rate of bans are estimated, and changes over the course of the 1990s and their relation to smoking rates and tobacco control policies are examined. RESULTS: The prevalence of work and home bans has increased considerably between 1992/93 and 1998/99. By 1999, over 65% of the population age 15 and above work in places with smoking bans, and over 60% live in homes with bans. We found that states with lower than average ban rates in 1993 tended to have had larger increases in ban rates between 1993 and 1999. We also found that home and work bans became more prevalent in states with initially low smoking rates, and that the growth in home bans coincided with a declining prevalence of smoking. States with higher levels of bans by 1999 also tended to have higher cigarette taxes, stricter clean air laws, and media/comprehensive campaigns in place. CONCLUSIONS: The results indicate that lower smoking rates are associated with higher rates of work and home bans, although substantial progress has also been made by those states with initially low rates of bans. While further work is needed to establish the direction of causality, it would appear that reductions in smoking rates, either through stronger tobacco control policies or otherwise, may reduce exposure to tobacco smoke not only by reducing the number of smokers, but also through increasing the number of firms and homes with smoking restrictions.

Family Health↗
PubMed1994

Short-term effects of air pollution on daily mortality in Athens: a time-series analysis.

BACKGROUND: Athens has a serious air pollution problem which became evident in the early 1970s. Studies for the years 1975-1982 have indicated a positive association of sulphur dioxide (SO2) with total daily mortality. Since 1983 the pollution profile in Athens has gradually changed but the levels of smoke, SO2 and carbon monoxide (CO) remain relatively high. METHODS: The association of air pollution with daily all-cause mortality in Athens for the years 1984-1988 was investigated using daily values of SO2, smoke and CO. Autoregressive models with log-transformed daily mortality as the dependent variable, were used to adjust for temperature and relative humidity (both lagged by 1 day), year, season and day of week, as well as for serial correlations in mortality. RESULTS: Graphic analysis revealed non-linear monotonically increasing relationships between total mortality and SO2, smoke and CO, with steeper exposure-response slopes at lower air pollution levels. Air pollution data lagged by 1 day had the strongest association with daily mortality. In three separate autoregression models for log(SO2), log(smoke) and log(CO) the regression coefficients for each were highly statistically significant (P < 0.001). Further multiple regression modelling showed that SO2 and smoke are both independent predictors of daily mortality, though to a lesser extent than temperature and relative humidity. The inclusion of CO in the model did not further improve the prediction of daily mortality. The magnitude of association is small, for instance, a 10% reduction in smoke is estimated to decrease daily mortality by 0.75% (95% confidence interval [CI]: 0.51-0.99). However, it cannot be accounted for by climatic and seasonal effects, so that a causal influence of air pollution on daily mortality seems plausible. CONCLUSIONS: These findings suggest that current air pollution levels in Athens (and many other industrialized cities) may be responsible for substantial numbers of premature deaths, and hence remain an important public health issue.

Air Pollutants↗
PubMed2005

Recent trends in smoking and the role of public policies: results from the SimSmoke tobacco control policy simulation model.

AIMS: After a period of steady decline in smoking prevalence, smoking rates leveled off in the United States between 1990 and 1997, but began falling between 1997 and 2003. Trends in smoking prevalence, and the role of tobacco control policies in affecting those rates, are examined. DESIGN: A computer simulation model is used in which smoking prevalence evolves through initiation and cessation, which are in turn influenced by tobacco control policies. METHODS: The results of the model are compared to smoking prevalence measures from the US National Health Interview Survey between 1993 and 2003. We also consider the role of tax/price, clean air laws, media campaigns and youth access policies in influencing these rates. FINDINGS: Both the SimSmoke model and data for recent years indicate that adult smoking prevalence changed little between 1993 and 1997, and even increased among youth. Between 1997 and 2003, smoking prevalence has been declining. Most age, gender and racial-ethnic groups show patterns similar to that of the entire population, with differences for those aged 18-24 years. The predominant trends were explained mainly by changes in price, with some residual effect of clean air laws, media campaigns and youth access laws. CONCLUSIONS: Among public tobacco control policies, price had the dominant effect on smoking prevalence between 1993 and 2003, because few states implemented other policies to the degree necessary to affect much change. Through continued tax increases, stronger clean air laws, extensive media campaigns and broader cessation treatment programs, there is the potential to have much larger reductions in smoking prevalence.

Adolescent↗
PubMed2003

In vitro effect of nicotine and cotinine on the susceptibility of LDL oxidation and hemoglobin glycosylation.

Nicotine, a major component of cigarette smoke, plays an important role in the development of cardiovascular disease and lung cancer in smokers. This study was designed to determine the in vitro effects of nicotine and its metabolite cotinine on the susceptibility of LDL to oxidation and hemoglobin glycosylation. Three different concentrations of each one (10, 15, 25 microg/ml) were used. Our data show that nicotine and cotinine are inhibitors for Cu(2+)-induced LDL oxidation but also they increase the glycosylation degree of hemoglobin. Nicotine at final concentrations of (10, 15, 25 microg/ml) increases the rate of hemoglobin glycosylation 25, 32 and 47%, respectively, and cotinine at final concentrations increase the rate of glycosylation 8, 10 and 12%, respectively. Therefore promoting hemoglobin glycosylation is one of the alternations caused by smoking that increase risk of cardiovascular disease.

Cardiovascular Diseases↗
PubMed1987

Irreversible inhibition of monoamine oxidase by some components of cigarette smoke.

Inhibitory activity towards monoamine oxidase has been found in a solution of cigarette smoke. The inhibition was irreversible. When tissue slices of rat lung were incubated in the cigarette smoke solution or alternatively, exposed directly to cigarette smoke, monoamine oxidase activities were reduced drastically. Similarly, human saliva after cigarette smoking also exhibits considerable MAO inhibitory activity. When the amine substrates p-tyramine, serotonin and beta-phenylethylamine were incubated with the cigarette smoke solution, lipophilic adducts were formed non-enzymatically. The irreversible inhibition of MAO by cigarette smoke may well be related to the low platelet MAO associated with cigarette smokers as previously reported. The implication of such cigarette smoke-caused reduction of MAO activity in relation to Parkinsonism is discussed.

Animals↗
PubMed1984

Kinetic and chemical evidence for the inability of oxidized alpha 1-proteinase inhibitor to protect lung elastin from elastolytic degradation.

The oxidation of human alpha 1-proteinase inhibitor results in the conversion of this protein into a form which cannot protect lung elastin from degradation by elastolytic proteinases. Data indicate that this is primarily because of the lowering of the association rate between the modified inhibitor and neutrophil elastase, as well as in a change in Ki from near 10(-14) to near 10(-10)M. This is consistent with the hypothesis that oxidation of alpha 1-proteinase inhibitor in the lung by cigarette smoke results in a lowering of the protection of this organ from elastolytic degradation.

Blood Proteins↗
PubMedDate not supplied

The smoke produced from the oxidative pyrolysis of perfluoro polymers: an ESR spin-trapping study.

Spin adducts are observed when the unfiltered smoke produced during the aerobic pyrolysis of perfluoro polymers (PFP) is bubbled through a solution of the ESR spin trap alpha-phenyl-N-tert-butylnitrone (PBN). The spin adducts include those from an oxy radical and the fluorine atom, and in addition the spin trap is oxidized to PBNOx. The spin adduct of a chlorine atom also is observed, presumably because of chlorine-containing impurities in the polymers. Tetrafluoroethylene is produced during the pyrolysis of PFP; therefore, we subjected tetrafluoroethylene to the same pyrolysis as was used for PFP, and we observe the same series of spin adducts. We suggest that the spin adducts formed from the whole, unfiltered smoke from PFP smoke may result both from free radicals that form during the pyrolysis of PFP and from the oligomerization of the tetrafluoroethylene produced during the pyrolysis. These spin-trapping results support the theory that reactive free radicals are present in PFP smoke and may contribute to PFP smoke toxicity.

Cyclic N-Oxides↗
PubMed2006

Carboxyhemoglobin and thiocyanate as biomarkers of exposure to carbon monoxide and hydrogen cyanide in tobacco smoke.

The determination of biomarkers in human body fluids is a useful tool, which allows the quantitative assessment of the exposure to chemicals or complex mixtures of chemicals and of early biological effects as a result of the exposure. Biomarkers require validation before their successful application in human studies. This review describes some general purposes of human biomonitoring and biomarkers including the requirements for validation. Risk assessment and harm reduction of smoking and tobacco products, respectively, is a very suitable field for the application of biomarkers. A brief historical review shows that the application of biomarkers of exposure and effect in human smoking goes back more than 150 years. Two 'classical' biomarkers of exposure to tobacco, namely carboxyhemoglobin (COHb and its equivalent carbon monoxide in exhalate, COex) and thiocyanate (SCN) in body fluids are discussed in terms of sources of exposure, metabolism, disposition kinetics and influencing host factors. Data on COHb/COex and SCN in nonsmokers and smokers as well as the power to discriminate between smokers and nonsmokers are presented. Both biomarkers are significantly correlated with the daily cigarette consumption. Smoking machine-derived yields of the precursors carbon monoxide and hydrogen cyanide were not correlated with COHb/COex and SCN, respectively. It is concluded that, while COHb/COex is a useful biomarker for assessing the smoke inhalation, preferably in controlled studies, the application of SCN in body fluids as a biomarker for smoking is limited, mainly due to the abundance of other sources for SCN.

Biomarkers↗
PubMed1988

Selenium-mediated reduction in the mutagenicity of cigarette smoke.

Cigarette smoke contains carcinogens and mutagens and affects the health of smokers. Recently, increased research has proven the potentially protective activity of selenium (Se) against heavy metal toxicity, cancer, and other health disorders. Accordingly, we have proposed the fortification of tobacco with Se to develop safer cigarettes. As a start in evaluating any biological effects of added Se, we have determined the mutagenicity of inhaled, mainstream (MS) cigarette smoke condensate (CSC), with and without Se, in the preincubation assay of the Ames test. Initially, it was shown that Se, as sodium selenite, was not mutagenic at high concentrations (up to 80 micrograms/plate) with strains TA1538 and TA1978. Subsequently, the effects of different levels of Se, added to MS CSC, were examined with TA98, TA100, and TA1538. On the average, addition of 10 micrograms Se produced mutagenicity reductions of about 50%. Higher levels of added Se yielded further reductions. Cigarette sidestream (SS) smoke, collected between puffs, was also tested. Again, Se added to SS-CSC gave similar reductions, confirming its antimutagenic effect for both mainstream and sidestream smoke.

Animals↗
PubMed2002

Tobacco use: the impact of prices.

Cigarette smoking continues to be a leading cause of death in the United States, imposing substantial measurable costs to society. Smoking killed over 440,000 people in the United States each year during the period 1995-1999. If current smoking trends continue, over 5 million people currently younger than 18 will die prematurely from tobacco-related diseases. Increases in excise taxes have been shown to be effective in reducing smoking among youth. However, the adoption of tax increases in any jurisdiction is susceptible to many challenges. Furthermore, smuggling of tobacco products and sales of tobacco products over the Internet threaten the effectiveness of tobacco tax increases. This article discusses the effectiveness of excise tax increases on prevention and reduction of smoking. It also discusses factors that influence the legislative adoption of such increases. Finally, it examines potential threats to the use of tobacco taxes as a prevention tool.

Adolescent↗
PubMed1989

Increased frequency of oxidant-mediated DNA strand breaks in mononuclear leucocytes exposed to activated neutrophils from cigarette smokers.

Following activation with the synthetic chemotactic tripeptide FMLP, potentiated by cytochalasin B (CB), blood neutrophils from cigarette smokers generated greater amounts of both extracellular and intracellular reactive oxidants than cells from non-smoking control subjects. FMLP/CB-activated neutrophils from cigarette smokers also inflicted increased oxidant-mediated damage to the DNA of cocultured mononuclear leucocytes, which was prevented by the inclusion of superoxide dismutase and catalase individually and in combination. These observations demonstrate that cigarette smoking primes phagocytes to generate increased amounts of potentially carcinogenic reactive oxidants.

Catalase↗
PubMed2003

Oxidation of glutathione and cysteine in human plasma associated with smoking.

Cigarette smoking contributes to the development or progression of numerous chronic and age-related disease processes, but detailed mechanisms remain elusive. In the present study, we examined the redox states of the GSH/GSSG and Cys/CySS couples in plasma of smokers and nonsmokers between the ages of 44 and 85 years (n = 78 nonsmokers, n = 43 smokers). The Cys/CySS redox in smokers (-64 +/- 16 mV) was more oxidized than nonsmokers (- 76 +/- 11 mV; p <.001), with decreased Cys in smokers (9 +/- 5 microM) compared to nonsmokers (13 +/- 6 microM; p <.001). The GSH/GSSG redox was also more oxidized in smokers (-128 +/- 18 mV) than in nonsmokers (-137 +/- 17 mV; p =.01) and GSH was lower in smokers (1.8 +/- 1.3 microM) than in nonsmokers (2.4 +/- 1.0; p <.005). Although the oxidation of GSH/GSSG can be explained by the role of GSH in detoxification of reactive species in smoke, the more extensive oxidation of the Cys pool shows that smoking has additional effects on sulfur amino acid metabolism. Cys availability and Cys/CySS redox are known to affect cell proliferation, immune function, and expression of death receptor systems for apoptosis, suggesting that oxidation of Cys/CySS redox or other perturbations of cysteine metabolism may have a key role in chronic diseases associated with cigarette smoking.

Aged↗