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Characteristics of smokers, non-smokers and ex-smokers among 10,000 adult males inIsrael. II. Physiologic, biochemical and genetic characteristics.

Physiologic, biochemical and genetic characteristcs of current smokers, non-smokers and ex-smokers were compared among a study population of almost 10,000 working men aged 40-65 years in Israel. Many significant differences were found, although most differences were small. Current and ex-smokers were slightly taller than non-smokers, and height was correlated to amount smoked. Current smokers had lower weights (absolute and adjusted)8 skunfolds, systolic and distolic blood pressures, and uric acid levels, but had higher pulse rates and higher concentrations of total and beta-cholesterol, hemoglobuin and hematocrit. They showes, however, lower alpha-cholesterol (absolute and relative) concentrations. All the above differences were dose-response-related but discriminant analysis incorporating socio-demographic and behavioral correlates revealed only a moderate degree of combined discrimination. The conclusion is that, while cigarette smokers differ from non-smokers in many ways, the overall difference is umimpressive. This explains why, in prospective analysis, increased mortality and morbidity among smokers could not be attributed to confounding variables. Ex-smokers resembled current smokers in height and cholesterol but were closer to non-smokers levels of weight, skinfolds, blood pressure, uric acid and alpha-cholesterol. Ex-smokers also had inermediate levels of hemoglobin and hematocrit. Cigar and pipe smokers differed from non-smokers only in their elevated levels of cholesterol and uric acid. There was no variation by smoking habits among blood groups of seven types. It is concluded that an overall similarity exists between different smoking groups mainly in terms of coronary risk factors, and that therefore, constitutional differences do no account for the increased mortality and morbidity among smokers.

Adult

Saliva and salivary pellicle composition and proteomic profile in smokers vs. non-smokers and its effect on dental erosion.

OBJECTIVE: To analyse the salivary composition and proteomic profile of saliva and the salivary pellicle in smokers compared to non-smokers, and to examine potential differences in the erosion-protective capacity of the salivary pellicle. METHODS: Twenty-five smokers and 25 non-smokers were included. Unstimulated and stimulated saliva samples were analysed regarding flow rate, pH, buffer capacity, calcium, phosphate, fluoride, and protein content. Saliva and salivary pellicle samples were analysed by data-independent acquisition mass spectrometry (DIA-MS) for proteome profiling. In an in situ experiment, intraoral splints were loaded with bovine enamel and dentine specimens for 120 min. Pellicle-covered specimens were extraorally eroded (HCl, pH 2.3, 60 s). Calcium release was determined photometrically and compared to pellicle-free controls. RESULTS: Except for phosphate in stimulated saliva (padj.=0.003), salivary parameters were not significantly different between smokers and non-smokers. Proteome profiling detected 1759±154 proteins (cumulative 1963) in saliva, and 4262±362 proteins (cumulative 4625) in the salivary pellicle. The relative abundances of 282 (unstimulated saliva), 338 (stimulated saliva), and 4 (salivary pellicle) protein groups differed significantly between smokers and non-smokers. Functional enrichment analysis of differentially abundant human proteins revealed biological processes such as coagulation, immune response, and carcinogenic reactive oxygen species processes to be impacted by smoking. The salivary pellicle had a significant erosion-protective effect in enamel compared to the control (41.4 ± 6.3 nmol/mm2), but no differences between smokers (33.2 ± 10.6 nmol/mm2, padj.=0.001) and non-smokers (32.7 ± 8.6 nmol/mm2, padj.=0.001) were found. CONCLUSION: The proteomic profiles of both unstimulated and stimulated saliva and the salivary pellicle differ between smokers and non-smokers. CLINICAL SIGNIFICANCE: Despite the different proteomic profiles indicating a significant impact of smoking on the oral cavity, the erosion-protective capacity of the salivary pellicle of smokers and non-smokers does not differ.

Dental Pellicle

Cigarette smoking in pregnancy: differences in peripheral circulation between smokers and non-smokers.

Ten smokers and ten non-smokers were followed serially from 12 to 16 weeks of pregnancy to six weeks postnatally. Measurements of calf and foot blood flow and toe and finger skin temperature were made at 4 to 6 week intervals in both groups, and the acute effects on the peripheral circulation of smoking one standard cigarette were also measured in the smokers at each stage of pregnancy. Comparison between the smokers and non-smokers showed that in the last trimester of pregnancy smokers had significantly higher foot blood flow and toe and finger temperature than non-smokers. These circulatory variables rose during the period of pregnancy studied in smokers but altered little in non-smokers. There was no significant difference in calf blood flow between the groups. Smoking a cigarette during pregnancy caused a fall in foot blood flow and in finger and toe skin temperature. Smoking increased calf blood flow between 12 and 25 weeks of pregnancy but decreased it in late pregnancy. Previous investigations of blood flow in pregnancy have not differentiated between smokers and non-smokers. It is suggested that the rise in foot blood flow and skin temperature believed to occur generally during pregnancy applies mainly to smokers. Some possible reason for differences in skin blood flow between smokers and non-smokers in pregnancy are discussed.

Adult

Smokers, non-smokers and the attribution of addiction.

Questionnaries concerned with attitudes towards cigarette smoking were completed by 368 respondents who were taking part in a survey of audience reactions to one week's television programmes. Cigarette smokers were asked how difficult it would be for them to give up cigarettes, whether they would like to do so, whether they felt they were addicted to cigarettes, and how often a cigarette gave them real pleasure. Non-smokers were asked parallel questions to determine their perceptions of the average cigarette smoker. In comparison to how smokers saw themselves, non smokers saw the average smoker as more addicted, and as deriving less pleasure from cigarettes. Smokers who saw themselves as more addicted felt it would be more difficult for them to give up, smoked more cigarettes per day, said they would like to give up more, and derived somewhat more pleasure from cigarettes. Among those who had never smoked cigarettes, the attribution of addiction to the average smoker was related only to perceived difficulty of giving up. Lesser self-attributed addiction was also relevant to the prediction of which smokers claimed to be trying to reduce or give up smoking. Implications of these data for attribution theory, and for health education, are discussed.

Adolescent

Effect of cigar smoking on carboxyhaemoglobin and plasma nicotine concentrations in primary pipe and cigar smokers and ex-cigarette smokers.

Five ex-cigarette smokers and five primary pipe and cigar smokers each smoked a large cigar. Carboxyhaemoglobin (COHb) and plasma nicotine levels were measured. In the ex-cigarette smokers mean COHb rose from 2.9% to 9.6% and plasma nicotine from 79.0 nmol/l to 281 nmol/l (12.8-45.6 ng/ml). This response was similar to that of cigarette smokers smoking cigarettes, which indicated that the subjects had inhaled and absorbed significant amounts of nicotine. In the primary pipe and cigar smokers the mean COHb rose from 0.8% to 1.0% and the plasma nicotine from 21 nmol/l to 32 nmol/l (3.4-5.2 ng/ml), indicating neither significant inhalation nor significant nicotine absorption.Since ex-cigarette smokers do not seem to lose their habit of inhaling when they change to cigars, measures aimed at persuading smokers to switch to cigars will have little effect on their health. Pipe and cigar smokers who have never smoked cigarettes do not inhale, which probably accounts for their reduced incidence of coronary heart disease and lung cancer. But they also appear not to absorb nicotine, which suggests that nicotine is absorbed largely from the lung and that the buccal mucosa is unimportant. It also raises the interesting question of why primary pipe and cigar smokers do smoke.

Adult

Intra-alveolar macrophage numbers in current smokers and non-smokers: a morphometric study of tissue sections.

BACKGROUND: The alveolar macrophage is believed to be important in the defence of the lung and possibly in the pathogenesis of lung disease. Cell counts in bronchoalveolar lavage fluid have suggested that smokers have an increased number of alveolar macrophages but have not enabled the number to be related to a measure of lung structure. METHODS: The number of alveolar macrophages was counted in histological sections from lung resection specimens from a group of smokers and non-smokers. The results were related to a measurement of lung structure obtained by means of an automated morphometric technique and expressed in terms of units of lung volume or of lung surface area. RESULTS: The smokers had a significantly increased number of alveolar macrophages per unit lung volume and per unit surface area, through the relative increase was less than has appeared from bronchoalveolar lavage studies. When smokers and non-smokers with similar lung structure were compared the smokers had more alveolar macrophages, indicating that smoking and not loss of lung structure is responsible for the increase. CONCLUSIONS: Smokers had more alveolar macrophages than non-smokers when the number was expressed quantitatively with respect to the underlying architecture. Changes in cell populations postulated to be important in the pathogenesis of disease within the lung should be related to lung architecture because this may vary considerably between individuals.

Adult

Effects of cigarette smoking or ingestion of nicotine on platelet 5-hydroxytryptamine (5-HT) levels in smokers and non-smokers.

Platelets of healthy smokers and non-smokers were prepared and their content of 5-hydroxytryptamine was determined by HPLC with electrochemical detection. Platelet 5-HT levels in smokers (728 +/- 156 pmol per 10(8) platelets, mean +/- SEM, n = 9) were significantly higher than those in non-smokers (353 +/- 156 pmol per 10(8) platelets, n = 11). Smoking of a single cigarette caused a transient increase in platelet 5-HT levels by about 350% in non-smokers, but had no additional effect in smokers. Similarly, chewing of nicotine gum (4-8 mg nicotine) resulted in a transient increase in platelet 5-HT by about 100% in non-smokers, but not in smokers. In conclusion, smoking of cigarettes can cause an increase in platelet 5-HT, most likely via an enhanced supply of 5-HT from enterochromaffin cells which can be stimulated via nicotine receptors.

Administration, Oral

7-Methylguanine levels in DNA of smokers' and non-smokers' total white blood cells, granulocytes and lymphocytes.

The effect of smoking was investigated on the formation of 7-methylguanines in human peripheral white blood cells. DNA was isolated from total white blood cells, granulocytes and lymphocytes from 10 smokers and 10 non-smokers. 32P-Postlabeling was performed by using anion-exchange chromatography enrichment of adducts. In smokers the mean DNA adduct levels were 6.9, 4.7 and 23.6 7-methylguanine residues/10(7) nucleotides in total white blood cells, granulocytes and lymphocytes respectively. The corresponding values in non-smokers were 3.4, 2.8 and 13.5 adducts/10(7) nucleotides. The mean adduct level was significantly higher in lymphocytes than in total white blood cells or granulocytes both in smokers and in non-smokers. The mean adduct levels differed significantly between smokers and non-smokers.

Adult

Occurrence of periopathogens in smoker and non-smoker patients.

The aim of the present study was to elucidate the interrelationship between cigarette smoking and the occurrence of periopathogens, i.e., Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and Bacteroides intermedius. The study was based on 145 patients with clinically severe periodontitis, 52 men (age range 32-73 years) and 93 women (age range 32-74 years). 83 patients were smokers (> or = 15 cigarettes/day) and 62 non-smokers. Bacterial samples were collected from one site with a probing depth > or = 6 mm for each individual. There were no statistically significant differences in bacterial counts between smokers and non-smokers (p > 0.05). The relative frequencies of smokers and non-smokers positive for A. actinomycetemcomitans were 31% and 31%, for B. gingivalis 42% and 44%, and for B. intermedius 65% and 53%, respectively. The differences between smoking groups were not statistically significant (p > 0.05). The occurrence in different combinations of these bacteria was also determined. There were no statistically significant differences between smoking and combinations of periopathogens (p > 0.05). The results suggest that smoker and non-smoker patients do not differ with regard to occurrence, relative frequency or different combinations of A. actinomycetemcomitans, B. gingivalis and B. intermedius.

Adult

Characteristics of smokers, nonsmokers and ex-smokers among 10,000 adult males in Israel. I. Distribution of selected sociodemographic and behavioral variables and the prevalence of disease.

Sociodemographic and behavioral characteristics of nonsmokers and smokers were compared in a large sample of working men aged 40 to 65 years. The prevalence of several diseases was compared. There was a significantly higher percentage of smokers among those born in the Middle East (outside Israel) and North Africa. Smokers were characterized by crowded housing (a high number of persons per room); low levels of education; little leisure-time physical activity; and a tendency to be nonreligious. Current cigarette smoking gradually decreased with age, while smoking a cigar or pipe only, increased. The demographic and behavioral profile of current smokers in general, and of "heavy" (larger than or equal to 21 cigarettes/day) smokers in particular, resembled that of those who had smoked at any time. Both the current and the "heavy" smokers were more often later immigrants to Israel, had more children, and were physically active at work, frequently being engaged in manual labor or technical work. Prevalence of myocardial infarction, angina pectoris, definite peripheral arterial disease, intermittent claudication and peptic ulcer was significantly higher among those who had smoked at any time. Apart from silent myocardial infarction and intermittent claudication, subjects with these conditions also included a significantly higher percentage of former smokers. Former smoking was also related to age, number of years in the country, less crowding at home, low activity at work, and a low calorie intake (particularly of protein and carbohydrates).

Activities of Daily Living

Oxygen-dissociation kinetics in the blood of smokers and non-smokers: interaction between oxygen and carbon monoxide at the hemoglobin molecule.

The importance of smoking as a possible factor in coronary heart disease (CHD) may be related to the effect of carbon monoxide (CO) on oxygen exchange at the hemoglobin molecule (Hb). We examined the kinetics of this process in vitro and ex vivo using a fast-reaction technique (stopped-flow) whereby the dissociation-rate constant of oxygen was determined in the blood of smokers and non-smokers and at fixed HbCO-concentrations in non-smokers blood. In non-smokers, carbon monoxide saturated blood was obtained by gassing with carbon monoxide and mixing the samples with appropriate carbon monoxide free blood to achieve HbCO-concentration in the range of 10-60%. The reaction time course for the oxygen-dissociation was divided into a non-linear-initial phase (loss of the first oxygen molecule) and a subsequent linear phase. The oxygen-dissociation velocity decreased from 96.5 x 10(3) ms-1 to 42.7 x 10(3) ms-1 in the linear phase at pH 7.4 and decreased from 29.2 x 10(3) ms-1 to 20.9 x 10(3) ms-1 at pH 9.2 when the HbCO-concentration was increased to 63%. For the initial phase at pH 7.4, the dissociation velocity decreased depending on the HbCO-concentration. In non-smokers 50% of the bound oxygen was released in 17.5 +/- 2.3 ms (n = 13) whereas in smokers 19.4 +/- 1.8 ms (n = 14) (p less than 0.05) was required.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

The concentration of cadmium in renal tissue from smokers and non-smokers.

The concentration of cadmium is determined by atomic absorption spectrophotometry of renal tissue excised at autopsy. Tissue from 19 non-smokers and 42 smokers of either sex in the age group 45-65 years has been analysed. The concentration of cadmium in kidneys from 16 subjects who had been smoking pipes, cigars or cheroots did not differ significantly from the concentration in non-smokers and cigarette smokers. On the other hand, in both normotensive and hypertensive individuals, the concentration of cadmium in kidneys from cigarette smokers was twice as high as in kidneys from non-smokers.

Aged

A difference in the composition of bronchial mucus between smokers and non-smokers.

The ratio of the amount of sulphated to sialic acid mucin (Su/Si) in the mucous glands of the human tracheobronchial tree has been investigated in seven smokers and seven non-smokers. The two mucins were studied in histological sections stained by the high iron diamine/Alcian blue pH 2-5 sequence and assessed by a point-counting method. Su/Si was greater in the smokers than in the non-smokers, who were almost completely distinguished by this ratio. A decrease in the ratio with each generation of branching from the trachea down the inferior lingular bronchial segmental pathway was seen in both the smoking and non-smoking groups. Analysis of the logarithm of Su/Si showed the smoking group means to be 2-3 times that of the non-smokers at each generation, and over both groups the average decrease down successive generations was given by a factor of 0-9.

Aged

The immunological response to tobacco antigens in the smoker. I. Specific precipitins against tobacco antigens in the serum of healthy cigarette smokers.

A study on the presence of specific precipitins against tobacco antigens was done in a population of 361 healthy cigrette smokers and in a group of 60 healthy non-smokers. The tests were made by the gel diffusion technique of Ouchterlony using tobacco extract prepared by the Coca method. A positive precipitation reaction was observed in 11.8 per cent of the smokers' sera examined but never in the non-smokers group. The reaction occurred in subjects of both sexes and was neither dependent upon how long they had smoked nor on the number of cigarettes smoked daily. In the authors' opinion, the formation of precipitins against tobacco antigens may be the result of a sensitivity reaction. It is therefore possible that in predisposed individuals immune complexes of precipitins and tobacco antigens may be formed. They could be responsible for some cardiovascular disorders occuring in smokers. In order to confirm such a hypothesis, a study was carried out recently by the authors on a large group of patients suffering from coronary disease.

Adolescent

Attitudes, perceptions, and risk-taking behaviors of smokers, ex-smokers, and nonsmokers.

A sample of American adults completed questionnaires relevant to cigarette smoking. The questions were related to three areas: risk, perceptions of their or others' smoking, and satisfaction with life and health. The results revealed that smokers were greater risk-takers, that they perceived their smoking to be due to both physical and psychological addictions, and that they expressed less satisfaction and control. Results also indicated that smokers who saw their smoking as being addictive tended to be less satisfied with their health and felt less control over their lives. On the other hand, those smokers who were more likely to deny the health risks did not differ from either non- or ex-smokers on any of the satisfaction or control questions.

Adult

Expression of O6-methylguanine--DNA methyltransferase and uracil--DNA glycosylase in human placentae from smokers and non-smokers.

DNA repair capacity is likely to be a critical factor in mutagenesis and carcinogenesis, as well as for the response to some cytostatics. We have studied inter- and intra-individual variation in the activities of O6-methylguanine--DNA methyltransferase (O6-MT) and uracil--DNA glycosylase (UDG) in 35 placentae from smokers and non-smokers. The maximum interindividual variation in the activities of O6-MT and UDG were 8.3- and 7.7-fold, respectively. The corresponding intraindividual variations were 2.7- and 3.3-fold. Generally, a high level of O6-MT activity was accompanied by a high O6-MT mRNA level, but no such correlation was seen for UDG. These results were not due to degradation of the enzymes or mRNAs after delivery. No correlation between the activities of O6-MT and UDG was observed, indicating that they are differentially regulated. A 1.4-fold (P < or = 0.05) higher activity of O6-MT was observed in smokers as compared to non-smokers, indicating a small, but statistically significant difference. No significant difference was observed for UDG. Our results demonstrate that DNA repair capacities vary largely between different individuals, and that environmental factors may modulate the expression of DNA repair enzymes.

DNA Glycosylases

Nicotine and cotinine in the cervical mucus of smokers, passive smokers, and nonsmokers.

Although epidemiological studies suggest that cigarette smoking is a risk factor for cervical cancer, further evidence is required to document the biological plausibility of this relationship. This study obtained cervical mucus, using a cervical flush technique, from 50 patients in a neoplasia clinic. Nicotine was detected in the cervical mucus of all 25 smokers and cotinine in the mucus of 84% of the smokers; nicotine and cotinine levels were correlated (P < or = 0.10) with both the number of cigarettes usually smoked and the number smoked in the last 24 h. Nicotine and cotinine levels for passive smokers and nonexposed women were much lower than for women who currently smoked, with little difference found between the nonsmoking women who did and did not report passive smoke exposure. In the one woman who reported smokeless tobacco use, both nicotine and cotinine were detected at much higher levels than for other nonsmoking women. These results indicate that tobacco constituents do indeed reach the uterine cervix, suggesting that they could play a causal role in the development of cervical cancer.

Adolescent