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PubMed1999

Quantitative and qualitative evaluations of brief interventions to change excessive drinking, smoking and stress in the police force.

AIMS: To evaluate the effects of a brief intervention to reduce excessive drinking, smoking and stress among police. DESIGN: (1) Controlled intervention trial with pre and post-intervention assessment approximately 8 months apart; (2) focus group identification of relevant factors). SETTING, PARTICIPANTS: Assessment was carried out of 954 NSW (Australia) police at 19 stations within two matched districts in the Sydney metropolitan area. Five focus groups were carried out with 43 randomly selected police from the matched districts. MEASUREMENTS: Weekly alcohol consumption and binge drinking, smoking and symptoms of stress were measured by a self-administered Health and Fitness Questionnaire. Recorded responses to set questions provided qualitative data. RESULTS: Participation was high (89%) at both quantitative assessments. Alcohol consumptions, particularly among men, was high at both baseline and follow-up assessments, although comparisons between groups across occasions showed no significant intervention effects. Excessive drinkers and those reporting moderate to severe stress levels reported more sick leave days (p < 0.05, p < 0.05). A significant increase in awareness of alcohol policies in the work-place showed in both experimental and control groups over time (p < 0.01). The percentage of smokers declined significantly in both intervention and control groups. Overall, women had significantly more symptoms of stress than men. Only 20% of police thought they would seek advice from work-place staff about alcohol consumption, 14% for smoking and 61% for stress. In the qualitative study, employees generally distrusted their organization's involvement in health unless work performance was affected. Seeking professional assistance for life-style issues was viewed as a sign of weakness. Alcohol use was seen as a way of obtaining information or group membership, self-medication and socializing. CONCLUSIONS: The brief interventions did not produce significant improvements in three life-style factors beyond positive trends in alcohol consumption among women and general reductions in smoking among both study groups. Combining quantitative and qualitative approaches helped identify interactive individual and organizational factors which influence behavioural and cultural norms.

Adolescent↗

PubMed1998

Urinary excretion of 5-(hydroxymethyl) uracil in healthy volunteers: effect of active and passive tobacco smoke.

The urinary excretion of 5-(hydroxymethyl)uracil (5-HMUra), one of the major oxidative modifications of thymine, was investigated in 134 healthy volunteers living in North Italy. Overnight urine was collected, and a questionnaire was completed on smoking habits and exposure to environmental tobacco smoke (ETS). 5-HMUra was analyzed by GC/MS, following urine purification by HPLC. 5-HMUra excretion showed an approximately normal distribution, ranging from 0.08 to 0.84 (mean 0.44) nmoles/kg/8 hr and from 3.2 to 18.7 (mean 8.5) nmoles/mmoles creatinine. 5-HMUra excretion was significantly higher in women than in men and in smokers than in non-smokers when results were expressed as the ratio to creatinine. Slightly higher levels of 5-HMUra excretion, expressed as nmoles/mmoles creatinine, were also found in subjects highly exposed to ETS, monitored either as the number of hours of exposure or as the number of smokers in the workplace and at home. Our results show that the urinary excretion of 5-HMUra is higher than that of other oxidized nucleobases, including 8-oxo-7,8-dihydroguanine, and can be slightly modified by environmental factors such as tobacco smoke. These findings suggest that measurement of urinary excretion of 5-HMUra could be useful as a biomarker of oxidative DNA damage and repair, though further research is needed to support these data.

Adult↗

PubMed1989

Lung function in children of low birth weight.

Lung function was recorded in a cohort of 130 age specific children of low birth weight (under 2000 g) and a reference population of 120 unselected local schoolchildren at 7 years of age. Children of the cohort were similar in height and forced vital capacity to the reference group, but had significantly reduced forced expiratory volume in 0.75 second and expiratory flow indices. Although neonatal respiratory illness was associated with reduced airway function, we were unable to confirm that this was a consequence of oxygen treatment or mechanical ventilation. Low birth weight, however, was closely associated with poor airway function independent of neonatal respiratory illness. Other factors of importance included the male gender and maternal smoking. The reduction in airway function observed in the low birthweight children was associated with cough but not wheeze. The disparity between the relatively well preserved vital capacity and reduced airway function suggests that very low birth weight, and hence prematurity, has its greatest effect on the subsequent growth of airway function. The absence of an association between neonatal oxygen score or mechanical ventilation and childhood lung function suggests that the long term effect of neonatal respiratory treatment is small compared with that of birth weight, maternal smoking, and male sex.

Birth Weight↗

PubMedDate not supplied

Maternal smoking, intrauterine growth restriction, and placental apoptosis.

Pregnant women who smoke are at greater risk of delivering a growth-restricted infant than nonsmoking mothers. We wanted to see if apoptosis could be involved in the mechanisms behind smoke-induced growth restriction, and our aim was to compare apoptosis in the placenta of smoking mothers giving birth to growth-restricted infants and nonsmoking mothers with infants of appropriate weight. The project was conducted at the Magee--Womens Hospital and Magee--Womens Research Institute, University of Pittsburgh, PA. Histological sections from 20 placentas were selected from smoking mothers who had given birth to small-for-gestational-age infants (birth weight < or = 2 SD). The controls were gestational-age matched nonsmoking mothers with infants having appropriate-for-gestational-age weight. The TUNEL method was used to demonstrate DNA fragmentation in nuclei, and a monoclonal antibody M30, specific for a neo-epitope on cytokeratin 18, was used to identify apoptotic epithelial cells. The positive nuclei (TUNEL) and positive cells (M30-positive cytoplasm) were counted blindly both in villous tissue and in decidual/basal plate tissue. M30-positive cells in villous tissues were significantly increased in placentas from smoking mothers compared to nonsmoking mothers. When evaluated by the TUNEL method, the difference between the two groups of women was not significant. Our study shows that apoptosis was increased in the placentas of smoking mothers with growth-restricted infants. The difference between the two groups was mainly in the syncytiotrophoblast layer and in connection with perivillous fibrin deposition. Cigarette smoke with reduction in blood flow has previously been shown to increase apoptosis, and it is possible that this could be one of the mechanisms playing a role in the growth restriction.

Apoptosis↗

PubMed2002

Relationship of respiratory symptoms with smoking status and pulmonary function in chronic spinal cord injury.

OBJECTIVE: The relationship of respiratory symptoms to pulmonary function parameters and smoking status was assessed in subjects with chronic (>1 year) spinal cord injury (SCI). METHODS AND PARTICIPANTS: As part of their annual physical examination, subjects were queried regarding respiratory symptoms and underwent pulmonary function studies. The 180 patients who successfully completed pulmonary function testing were evaluated, including 79 subjects with tetraplegia (56 nonsmokers and 23 smokers) and 101 subjects with paraplegia (78 nonsmokers and 23 smokers). FINDINGS: Logistic-regression analysis revealed the following independent predictors of breathlessness: level of injury (tetraplegia, paraplegia, odds ratio = 3.5, P < 0.0015), cough combined with phlegm and/or wheeze (CPWZ, odds ratio = 3.1, P < 0.015), total lung capacity percentage predicted (TLC <60%, odds ratio = 3.9, P < 0.02), and expiratory reserve volume (ERV < 0.6 L, odds ratio = 2.5, P < 0.05). Independent predictors of CPWZ were current smoking (odds ratio = 3.3, P < 0.004), breathlessness (odds ratio = 2.9, P < 0.03), and forced expiratory volume in 1 second (FEV1 <60%, odds ratio = 3.2, P < 0.01). CONCLUSION: Altered respiratory mechanics associated with tetraplegia contribute to breathlessness, restrictive ventilatory impairment (low TLC%), and reduced expiratory muscle strength (low ERV). These factors apparently overshadow adverse effects caused by smoking. Conversely, smoking and reduction of airflow (low FEV1%) were predictive of CPWZ, symptoms commonly associated with cigarette use.

Adult↗

PubMed1981

Reference values for respiratory function tests in males: prediction formulas with tobacco smoking parameters.

Prediction equations for respiratory function tests were obtained by multiple regression of data from 263 healthy males. The material was evenly distributed in the ages 20-70 years, about one third each of non-smokers, smokers and ex-smokers. Measurements were done of lung volumes (with body plethysmograph), airways resistance, ventilatory capacity including flow-volume registration, gas distribution and closing volume, transfer factor and static elastic recoil pressures of the lung with calculation of static compliance. The parameters age, height, weight, years of tobacco smoking and grams of tobacco smoked each day showed significant correlation with the outcome of the test in most of the respiratory function tests. Therefore a set of basic regression equations including these parameters were calculated. In addition an 'extended' set of equations was calculated for prediction of some tests with inclusion of nonlinear terms and the parameter 'years of abstinence from smoking.' The reduction in variance which followed inclusion of tested parameters was moderate (20-69%). There were significant differences between results of the present study and several previously published regression formulas.

Adolescent↗

PubMed2001

Smoking cessation through comprehensive critical care.

There has been little research on smoking cessation after critical illness. Smokers make up a high percentage of patients admitted to intensive care (ICU) and stopping smoking is one message that should be clearly given to recovering patients. The recovery period provides an important opportunity for patients to quit smoking as the period of sedation and ventilation allows patients to start nicotine withdrawal. Smoking cessation advice was included in a 6-week self-help ICU rehabilitation package comprising information and an exercise programme. Recovering ICU patients were randomised to receive either the routine follow-up of ward visits and ICU clinic appointments or routine follow-up plus the ICU rehabilitation package. Twenty out of thirty-one intervention patients and 16/30 control patients were smokers pre-ICU admission. At the 6-month follow-up, previous smokers given the rehabilitation package had a relative risk reduction for smoking of 89% (CI 98%-36%). Smoking cessation after critical illness is aided by the provision of a rehabilitation programme.

Adolescent↗

PubMed1995

Smoking cessation interventions for pregnant women: review and future directions.

A substantial proportion of disease and death in the US could be prevented if tobacco use was curtailed or eliminated. Low birth weight, pregnancy complications, and infant morbidity are but a few of the adverse outcomes experienced by pregnant and postpartum women and infants that result from cigarette smoking. Pregnancy may be an ideal time to intervene with smoking women. On learning of their pregnancy, many women reduce or quit smoking on their own. For those who do not quit, interventions during the childbearing year could provide additional incentive and support for complete cessation. Successful clinic-based interventions share similar characteristics and tailoring cessation messages to client populations may enhance the effectiveness of interventions. Assessing a smoker's degree of addiction and tailoring counseling for cessation according to the patient's readiness might enhance current clinical practices. Even with the most effective individual counseling, it is increasingly evident that additional strategies are needed to achieve population-wide reductions in smoking and its related health conditions. Examples of these efforts are increased taxation on cigarettes, community-based anti-tobacco programs, and increasing the number of smoke-free environments. Thus, in addition to clinic-based efforts, health professionals might take an active role in supporting the broad range of programmatic, legislative, and advocacy efforts.

Female↗

PubMed1996

Increase of a type of oxidative DNA damage, 8-hydroxyguanine, and its repair activity in human leukocytes by cigarette smoking.

To investigate the oxidative stress induced by cigarette smoking, the levels of a form of oxidative DNA damage, 8-hydroxyguanine (8-OH-Gua), and its repair activity in the leukocytes of current smokers, ex-smokers, and complete nonsmokers were measured. The mean level of 8-OH-Gua was 1.88-fold higher in smokers as compared to complete nonsmokers (the difference was statistically significant, P = 0.013). The mean 8-OH-Gua repair activity was 1.6-fold higher in smokers than complete nonsmokers (the difference was statistically significant, P = 0.0053). A positive association was observed for the 8-OH-Gua levels and its repair activity. Considerable interindividual variations in the 8-OH-Gua levels (current smokers, 3.5-fold; nonsmokers, 7.2-fold) and in its repair activity (current smokers, 7.5-fold; nonsmokers. 5.5-fold) were observed. These results demonstrate that not only smoking status but also life-style, environment, and genetic differences might have effects on the level of 8-OH-Gua and its repair activity in human leukocytes.

Adult↗

PubMed1992

Effect of cigarette smoking and of a transdermal nicotine delivery system on glucoregulation in type 2 diabetes mellitus.

The effect of nicotine absorbed transdermally from a patch (TNS) and from cigarette smoking on insulin secretion and action in Type 2 diabetes has been compared. Twelve Type 2 diabetic smoking patients, aged 51 y, with diabetes for 9 y, treated either with diet and/or oral hypoglycaemic agents, were studied on three occasions, according to a double-blind, placebo-controlled, cross-over design. The subjects were investigated 12 h after their last cigarette or application of one patch of TNS 30 cm2 or TNS placebo, or whilst smoking their usual cigarette. Insulin secretion was assessed by a glucagon (1 mg IV) stimulation test. On a second occasion, insulin action was assessed by a hyperglycaemic-hyperinsulinaemic clamp, the spontaneous hyperglycaemia of the fasting state (8.61 mmol.l-1) being maintained during a 4 h insulin infusion (at 0.1 mU.kg-1.min-1 for the initial 2 h, and 1 mU.kg-1.min-1 during the last 2 h). TNS and the cigarette did not affect endogenous insulin secretion as compared to placebo. During the initial 2 h of the clamp study, plasma insulin increased from 88 to 155 pmol.l-1, hepatic glucose production (3-3H-glucose) was less suppressed after TNS (4.31 mumol.kg-1.min-1) than after placebo (2.5 mumol.kg-1.min-1), but was more suppressed than after cigarette smoking (5.61 mumol.kg-1.min-1). In the last 2 h of the clamp (plasma insulin 646 pmol.l-1), glucose utilization was less stimulated after TNS (36.1 mumol.kg-1.min-1) vs placebo (39.8 mumol.kg-1.min-1), but more than after cigarette smoking (33.6 mumol.kg-1.min-1), primarily because of a decrease in glucose storage.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗

PubMed2005

Managing abdominal aortic aneurysms: treat the aneurysm and the risk factors.

Abdominal aortic aneurysms (AAAs) are not only a danger in themselves, they also signify underlying vascular disease that warrants intensive cardiovascular risk reduction, especially smoking cessation. Aneurysmal size and the patient's fitness for surgery are the main determinants of timing and method of elective repair. The choice of open surgery vs endovascular repair depends on the patient's condition, preference, and life expectancy, and the surgeon's experience.

Aortic Aneurysm, Abdominal↗

PubMedDate not supplied

Expanding health insurance coverage for smoking cessation treatments: experience of the Pacific Business Group on Health.

The business case for health insurance coverage of smoking cessation treatments by employers is a strong one. Smoking is one of the nation's costliest health problems, in both human and financial terms. The science behind smoking cessation treatment and promotion of treatment is strong; the cost effectiveness of smoking cessation treatment is among the highest in all of medicine, the time required before a positive return on investment is reasonable for employers, and the short-term costs of treatments are well estimated and manageable for health plans and employers. Armed with this business case, the PBGH Negotiating Alliance has expanded health insurance to include pharmacotherapy, over the counter or by prescription, and behavioral interventions. Because PBGH has been a national leader, we hope that other employers, employer coalitions, and public purchasers will follow their lead. The potential health effect of even small reductions in smoking are striking, and unlike other chronic illnesses, nicotine addiction is curable, at both individual and societal levels. Thus, if employers make the investment in smoking cessation and other tobacco control today, they face the real possibility that the need for such outlays could decrease in the future.

California↗

PubMed1997

Antipyrine metabolism in lung cancer patients and their relatives.

The existence of large interindividual differences in oxidation phenotypes and link of them with susceptibility to certain cancers was shown in animal and human studies. In a new approach plasma antipyrine half-lives have been measured in 60 lung cancer patients, 56 their first degree relatives and 75 healthy controls without cancer in their families. The mean antipyrine half-lives were significantly shorter (p < 0.005) in lung cancer patients group and in the group of their relatives when compared with the cancer free matched control group. This difference remained significant after adjusting for smoking gender and age. Six adenocarcinoma patients have shown significantly faster antipyrine metabolism than subjects with other histological types of lung cancer and obviously than healthy control.

Adult↗

PubMed1995

Detection of autoantibodies against oxidized low-density lipoproteins and of IgG-bound low density lipoproteins in patients with coronary artery disease.

The role of oxidized low-density lipoprotein (ox-LDL) in the pathogenesis of atherosclerosis has been the object of intense investigation. It has been proposed that, due to the antigenic properties of ox-LDL, the anti-ox-LDL antibody titre could represent a useful index of in vivo LDL oxidation. On the other hand, LDL immune complexes (LDL-IC) have been demonstrated in patients with coronary disease and could play an atherogenic role. The goal of our study was to investigate anti-malondialdehyde (MDA)-LDL autoantibodies and LDL-IC in a cohort of patients with coronary artery disease. Seventy control subjects and 70 coronary angiographically documented patients were compared; in addition 32 healthy male non-smokers were compared with 32 healthy male smokers (> 10 cigarettes/day). All patients were matched for age and cholesterolemia. Enzyme-linked immunosorbent assay was used to measure anti-MDA-LDL autoantibodies and LDL-IC. Titres of anti-MDA-LDL autoantibodies were not larger in patients with documented coronary artery stenosis and in smokers than they were in controls and non-smokers. The titre of LDL-IC was not higher in patients with coronary artery stenosis than in controls. The results thus indicate that in populations matched for age and cholesterolemia the titres of anti-MDA-LDL autoantibodies and the titre of LDL-IC are not increased in patients suffering from coronary artery stenosis. Furthermore, cigarette smoking does not induce higher titres of anti-MDA-LDL autoantibodies in healthy patients.

Aged↗

PubMed1996

Epidemiology of laryngeal cancer.

Laryngeal cancer is the second most common respiratory cancer after lung cancer. Its incidence is increasing over time in much of the world and this increase is generally accepted to be related to changes in tobacco and alcohol consumption. It is a relatively common cancer in men, but rarer in women. Moreover, interesting new issues have been raised recently about the influence of other possible risk factors. Evidence from epidemiological studies which supports the involvement of new risk factors in the aetiology of larynx cancer, as well as new perspectives in therapy, must be taken into consideration in order to realise primary and tertiary prevention. However, it remains clear that, even as new evidence continues to amass about a wide range of risk factors, primary prevention of the great majority of laryngeal cancers could be achieved by elimination of tobacco smoking and reduction of consumption of alcoholic beverages. With an additional contribution from adoption of a diet rich in fruits and vegetables, the great majority of laryngeal cancer appears to be preventable within our current epidemiological knowledge.

Adult↗

PubMedDate not supplied

Modification of human LDL by in vitro incubation with cigarette smoke or copper ions: implications for allergies, asthma and atherosclerosis.

Cigarette smoking has been linked to a higher risk of not only atherosclerosis and related diseases, but asthma and allergies as well. The mechanisms linking smoking to these diseases may be due in part to increased low density lipoprotein (LDL) modification. In the current study, we compared the modification in vitro of LDL isolated from healthy volunteers that had been exposed to either the gas phase of cigarette smoke or copper ion mediated oxidation. The study used as measures of modification/damage the levels of protein carbonyl groups, changes in electrophoretic mobility on agarose gel electrophoresis and levels of thiobarbituric-reacting substances. Other measures used to assess other aspects of LDL modification included SDS PAGE and immunoblotting. Both copper ion or exposure to the gas phase of cigarette smoke increased electrophoretic mobility of LDL but the increase was greater in the gas phase smoke group. In contrast, thiobarbituric reacting substance levels were increased primarily in copper oxidized LDL. Protein carbonyl levels were increased to a similar extent in both copper ion and smoke exposed samples. Addition of EDTA prevented the modifications found upon copper mediated oxidation of LDL, but EDTA did not prevent the modification of the gas phase cigarette smoke exposed LDL. In summary, the results indicate that protein carbonyl formation can be used as a measure of the modification of LDL particles and, using several different assessment techniques, there are distinct differences in the modified LDL produced by in vitro incubation with gas phase cigarette smoke relative to that found upon incubation of LDL with copper ion. The in vitro smoking-produced LDL modifications may potentially be relevant to the process of lipoprotein modification in vivo and to the subsequent biological effects of these modified lipoproteins on processes affected by the immune system involvement, such as atherosclerosis and allergy/asthma.

Aerosols↗

PubMed2002

Examining the effects of tobacco treatment policies on smoking rates and smoking related deaths using the SimSmoke computer simulation model.

OBJECTIVES: To develop a simulation model to predict the effects of different smoking treatment policies on quit rates, smoking rates, and smoking attributable deaths. METHODS: We first develop a decision theoretic model of quitting behaviour, which incorporates the decision to quit and the choice of treatment. A model of policies to cover the costs of different combinations of treatments and to require health care provider intervention is then incorporated into the quit model. The policy model allows for the smoker to substitute between treatments and for policies to reduce treatment effectiveness. The SimSmoke computer simulation model is then used to examine policy effects on smoking rates and smoking attributable deaths. RESULTS: The model of quit behaviour predicts a population quit rate of 4.3% in 1993, which subsequently falls and then increases in recent years to 4.5%. The policy model suggests a 25% increase in quit rates from a policy that mandates brief interventions and the coverage of all proven treatments. Smaller effects are predicted from policies that mandate more restricted coverage of treatments, especially those limited to behavioural treatment. These policies translate into small reductions in the smoking rate at first, but increase to as much as a 5% reduction in smoking rates. They also lead to substantial savings in lives. CONCLUSIONS: Tobacco treatment policies, especially those with broad and flexible coverage, have the potential to increase smoking cessation substantially and decrease smoking rates in the short term, with fairly immediate reductions in deaths.

Computer Simulation↗

PubMedDate not supplied

[Cardiovascular diseases after kidney transplantation].

Cardiovascular complications represent the leading cause of mortality in renal transplant recipients, with ischemic heart disease accounting for more than 50% of deaths. Besides the well known risk factors that affect the general population, risk for development of atherosclerosis in renal transplant patients is further increased by previous uremia and dialysis, as well as by the use of immunosuppressive agents. Diabetes mellitus, arterial hypertension, dyslipidemia, smoking, hyperhomocysteinemia, hyperuricemia, coagulation abnormalities, increased expression of cell adhesion molecules, persistent inflammation, frequent infections and obesity all increase the risk for development of atherosclerosis in transplanted patients. There is a growing body of evidence suggesting that the risk of cardiovascular disease falls significantly with smoking cessation, reduction of alcohol consumption, reduction of excessive weight, and appropriate and aggressive control of blood pressure and dyslipidemia. Patients should be instructed, and every effort should be invested to increase their compliance with the modified lifestyle and drug adherence. Novel immunosuppressive regimens tend to decrease the risk of atherosclerosis by being individualized according to the characteristics of the particular patient.

Atherosclerosis↗