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PubMed1994

Age at starting smoking and number of cigarettes smoked.

A cross-sectional analysis of a sample of 3235 males and 2513 females included in a structured framework of case-control studies of various neoplasms conducted in northern Italy assessed the relationship between age at starting smoking and amount of cigarettes smoked per day. Age-standardized proportions of light, moderate, and heavy smokers and mean numbers of cigarettes smoked per day according to age at starting, together with age- and sex-adjusted odds ratios of being a heavy smoker were computed. Age at starting smoking was strongly associated with the number of cigarettes smoked per day. This relationship was evident in men and women and at younger and elderly ages, although in women the mean numbers of cigarettes smoked was lower than in men, and age at starting was a stronger predictor of subsequent heavy smoking in people younger than 55 years than in the elderly. Among males who had started smoking before age 17, 64% smoked less than 25 cigarettes/d and 37% smoked 25 or more cigarettes; corresponding proportions were 73% and 27% among those who had started at age 30 or later. Age-standardized mean number of cigarettes smoked per day by men who started before age 17 was 23.5, compared to 20.0 for those who started at age 30 or later. Corresponding values for women were 16.8 and 10.5. Compared to those who started smoking at age 30 or later, the odds ratios of smoking more than 25 cigarettes/d for those who started before age 17 were 2.2 (95% confidence interval (CI), 1.6 to 3.0) for men and 5.4 (95% CI, 3.0 to 9.6) for women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Childhood friends who smoke: do they influence adolescents to make smoking transitions?

This study investigated longitudinally the extent to which childhood friends who smoke influence adolescents' smoking transitions, and compared that influence with that of parents who smoke. In a sample of 4744 children, results showed that the probability, per close friend, that a smoking close friend influenced the adolescent to make the first transition to trying smoking was 38% (95% CI: 28%, 46%); to make the second transition from trying to monthly smoking, 10% (95% CI: 5%, 15%); and to make the third transition from monthly to daily smoking, 11% (95% CI: 5%, 17%). Compared to parents' smoking, close friends' smoking was 12% (p=0.03) more influential for the first transition, no different for the second transition (p=0.53), and 16% (p=0.01) less influential for the third transition. Results provide new evidence suggesting that childhood close friends who smoke influence not only initiation but also escalation of adolescents' smoking. Results also confirmed the important role of parents' smoking. Targeting both childhood close friends' and parents' smoking would be valuable in prevention research.

Adolescent↗
PubMed2003

Association of parental smoking history with nicotine dependence, smoking rate, and psychological cofactors in adult smokers.

Family history is a powerful predictor of variation in risk of common diseases and conditions because it can represent the influence of both shared genes and shared environments. To investigate the relationship of parental smoking history with nicotine dependence and smoking rate, as well as with known psychological cofactors for smoking (depression, anxiety, alcoholism, disordered eating), we studied smoking adults who provided smoking history for both parents. We found that having two ever-smoking parents, in comparison to zero or one, was associated with higher nicotine dependence scores, cigarettes per day, and levels of anxiety in participant, with a trend for depression. Participants whose mothers smoked during pregnancy had significantly higher scores on nicotine dependence, smoking rate, and disordered eating than participants with either ever-smoking mothers who did not smoke during pregnancy or never-smoking mothers. These findings suggest that family history of smoking may be a key determinant of interindividual variation in smoking behavior, nicotine dependence, and psychological cofactors among smokers.

Adult↗
PubMed2003

The representation of smoking expectancies by single-word adjectives and their relationship to smoking characteristics.

A pool of single-word adjectives representing smoking outcome expectancies was derived and tested in two studies. In Study One, smoking-related words were generated and then clustered together to form 39 categories representing smoking expectancy nodes. Analysis of the number of times words in each category were generated indicated that expectancies varied as a function of smoking status (measured at two levels: Ever smoked daily vs. never smoked daily), smoking history (current vs. past smoker), and dependence (nondependent vs. dependent). In Study Two, participants rated the words in terms of expectations of smoking outcomes. A principal components analysis of the ratings indicated that three components accounted for 74.10% of the variance in participants' ratings: Component 1 (adverse effects), 30.92%; component 2 (positive image), 28.08%; and component 3 (positive mood), 15.09%. Further analyses revealed that ratings of words comprising the three components differed as a function of smoking status (measured at three levels: Never smoked daily, daily nondependent smoker, daily dependent smoker), with dependent smokers rating the outcomes associated with all three components as occurring more frequently when they smoked compared with nondependent smokers or those who never smoked daily. The results suggest that the single-word adjectives are appropriate for use in research investigating smoking outcome expectancies.

Adult↗
PubMed2004

Psychiatric disorders, familial factors, and cigarette smoking: II. Associations with progression to daily smoking.

This study examined (a) associations of progression to daily cigarette smoking with lifetime psychopathology, regular smoking by family members, and psychopathology in family members, (b) the degree to which disorders precede or follow progression to daily smoking, and (c) whether daily smokers differ as a function of nicotine dependence. Among 941 participants interviewed at three time points, 722 (77%) had experimented with cigarette smoking, 391 of whom (54%) progressed to daily smoking. Lifetime psychiatric diagnoses were obtained at each assessment. Biological parents and full siblings were interviewed for lifetime psychopathology and regular smoking. Progression to daily smoking was associated with lower parental education, major depression, alcohol and drug use disorders, attention-deficit/hyperactivity disorder (ADHD) or disruptive behavior disorders, antisocial personality disorder symptoms, regular smoking by father (but not mother or sibling), and one measure of psychopathology in family members (externalizing disorders, which consisted of ADHD, conduct disorder, oppositional defiant disorder, and antisocial personality disorder). When composite measures of internalizing disorders, externalizing disorders, familial smoking, and familial psychopathology were examined in a single model, only the externalizing disorders composite remained associated with both daily smoking and nicotine dependence. Only ADHD consistently preceded the onset of daily smoking. Nicotine dependence was associated with drug use disorders and alcohol use disorders. In conclusion, externalizing disorders had the strongest associations, both with progression to daily smoking among adolescents who initiate smoking and with nicotine dependence among the daily smokers. Limitations of the present study and future research directions are noted.

Adolescent↗
PubMed2005

School connectedness and daily smoking among boys and girls: the influence of parental smoking norms.

BACKGROUND: The objective was to test whether an association between school connectedness and smoking exists among Danish school children, and if so, to examine whether parental smoking attitude and parental smoking behaviour influenced this association. METHODS: Data were collected by the Danish contribution to the cross-national study Health Behaviour in School-Aged Children (HBSC) 1998. Analyses were performed on questionnaire-based data from 1537 students at grade nine from a random sample of schools in Denmark. RESULTS: An independent inverse association was found between school connectedness and smoking among both boys and girls. Parents' attitude to their children's smoking significantly modified this association among boys. Among girls the modifying effect was less marked. Neither among boys nor girls did parental smoking behaviour significantly modify the association between school connectedness and smoking, although a modifying tendency was observed among girls. CONCLUSIONS: The smoking behaviour of Danish adolescents may be influenced by complicated interactions of varying sets of experienced smoking norms, and any research project or preventive programme focusing on the influence of school life on adolescent smoking behaviour needs to consider the family smoking norms. Additionally, the results stress the important role of gender by indicating that the smoking behaviour of girls may be more sensitive to restricting social influences than the smoking behaviour of boys.

Adolescent↗
PubMed2006

Psychosocial factors associated with non-smoking adolescents' intentions to smoke.

Smoking is the most preventable cause of death in the United States. Most adult smokers began smoking during adolescence, making youth tobacco prevention an especially important public health goal. Guided by an extension of the theory of planned behavior (TPB), this study examined the role of psychosocial factors in accounting for adolescents' smoking intentions. Participants from three high schools (n = 785) were surveyed to assess smoking-related characteristics and behaviors as part of a statewide evaluation of tobacco prevention programming. Attitudes, subjective norms (and other normative factors) and perceived behavioral control were all associated with non-smokers' intentions to smoke. Having more favorable attitudes toward remaining tobacco free and perceiving that friends would not be supportive of smoking were both associated with decreased likelihood of intending to smoke. Normative influence and peer use were significant factors, such that having more friends who smoke was associated with increased odds of intent to smoke. Lastly, perceived difficulty to quit was related to smoking intentions, with higher confidence to quit significantly associated with intentions to smoke. Findings are consistent with the TPB--attitudes, normative factors and perceived behavioral control each helped account for non-smoking adolescents' intentions to smoke. Implications for theory and intervention building are discussed.

Adolescent↗
PubMed2000

Lifetime environmental exposure to tobacco smoke and primary lung cancer of non-smoking Taiwanese women.

BACKGROUND: For a female population with a high lung cancer mortality rate, such as Taiwanese women, who smoke relatively rarely, but live in an environment with high male smoking prevalence, the risk and population burden of lung cancer due to environmental tobacco smoke (ETS) are relatively important. METHODS: An age-matched case-control study was designed to investigate the effects of cumulative environmental exposure to tobacco smoke during childhood and adult life on lung cancer risk among non-smoking women in Taiwan. Information on passive smoking from all possible sources and life periods were obtained from interviews with 268 and 445 lifetime non-smoking cases and controls. Conditional logistic regression and synergism 'S' index were applied to the data to assess the independent and joint effects of passive smoking in different life stages while controlling for possible confounding variables. RESULTS: Risks of contracting lung cancer among women near-distantly exposed to the highest level of ETS in childhood (>20 smoker-years) and in adult life (>40 smoker-years) were 1.8-fold (95% CI: 1.2-2.9) and 2.2-fold (95% CI: 1.4-3.7) higher than that among women being never exposed to ETS, and the two variables accounted for about 37% of tumours in this non-smoking female population. Children were found to be more susceptible to ETS than adults and such early exposure was found to modify the effect of subsequent tobacco smoke exposure in adult life based on an additive interaction model. CONCLUSIONS: Environmental tobacco smoke exposure occurring in childhood potentiates the effect of high doses of exposure in adult life in determining the development of lung cancer. Smoking prohibition would be expected to protect about 37% of non-smoking Taiwanese women against lung cancer.

Adult↗
PubMedDate not supplied

Cigarette smoke exposure and development of infants throughout the first year of life: influence of passive smoking and nursing on cotinine levels in breast milk and infant's urine.

The effects of smoke exposure via mothers' milk and/or via passive smoking during the first year of life were investigated in a prospective longitudinal matched-pair study. The somatic and mental development of 69 infants whose mothers smoked more than five cigarettes per day throughout pregnancy and continued smoking after childbirth were compared with 69 children of non-smoking mothers. At birth, mean body weight of neonates from smoking mothers was significantly lower than the weight of neonates from non-smoking mothers. This weight difference between the two groups was no longer significant in infants at 12 months of age. With the methods employed by the authors, neither psychomotor nor mental development was affected by smoke exposure during pregnancy and early infancy. Infections of the lower respiratory tract were more frequent in the children of smoking mothers. These mothers weaned their babies earlier than non-smokers, but the different feeding behaviour did not influence any of the clinical parameters that were investigated in this study. In order to evaluate the extent of smoke exposure, cotinine was measured in children's urine and in breast milk once a month throughout the first year of life. Cotinine in the urine was significantly dependent on feeding behaviour: infants breast fed showed concentrations 10-fold higher than those who were bottle fed. Cotinine excretion in urine of infants from smoking mothers, who were not breast fed (nicotine exposure via passive smoking only) was even higher than that of adult passive smokers. If infants from smoking mothers were breast fed, their urinary cotinine excretion was in the range of adult smokers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Respiratory symptoms and lung function effects of domestic exposure to tobacco smoke and cooking by gas in non-smoking women in Singapore.

STUDY OBJECTIVES: To investigate the effects of passive exposure to tobacco smoke and gas cooking at home on respiratory symptoms and lung function of non-smoking women. SETTING: Evidence on the effects of passive smoking and exposure to nitrogen dioxide from gas cooking on the respiratory health of adults is limited and variable. Over 97% of women in Singapore do not smoke, and a principal source of indoor air pollution for housewives is passive smoking and gas cooking. DESIGN: This was a cross sectional (prevalence) study of a population based sample of 2868 adults aged 20 to 74 years in Singapore. A structured questionnaire administered by trained interviewers was used to collect data on passive smoking, gas cooking, respiratory symptoms, and other relevant variables. Passive smoking was defined as exposure to cigarette smoke from one or more members of the household who had ever smoked. Gas cooking was defined in terms of the weekly frequency of gas cooking, as well as the frequency with which the respondent's kitchen was filled with heavy cooking fumes (rarely, occasionally, often). Forced expiratory volume in one second (FEV1) was measured by using a portable Micro-spirometer. Multivariate analyses were used to estimate relative odds of association for respiratory symptoms and FEV1 effect, with adjustment for potential confounding variables. PARTICIPANTS: Of a total of 1438 women in the sample, 1282 women who had never smoked provided questionnaire data and 1008 women provided acceptable readings of FEV1 for analysis. MAIN RESULTS: Passive smoking was significantly associated with greater relative odds of usual or chronic cough and phlegm, wheezing, and breathlessness on exertion, as well as lower FEV1. Greater relative odds of respiratory symptoms were also associated with the weekly frequency of gas cooking, although these results were statistically insignificant. Chronic cough and phlegm and breathlessness on exertion, however, were significantly associated with the frequency with which the kitchen was filled with heavy cooking fumes. A lower FEV1 was found in women who cooked frequently (more than thrice a week). CONCLUSION: Domestic exposure to cigarette smoke and gas cooking is associated with increased risks of respiratory symptoms and impairment of lung function in non-smoking women in Singapore.

Adult↗
PubMed2004

Designated "no smoking" areas provide from partial to no protection from environmental tobacco smoke.

OBJECTIVE: To determine the efficacy of designated "no smoking" areas in the hospitality industry as a means of providing protection from environmental tobacco smoke (ETS), and whether certain design features assist in achieving this end. METHODOLOGY: In the greater metropolitan region of Sydney, a representative group of 17 social and gaming clubs, licensed to serve alcoholic beverages and in which, apart from designated areas, smoking occurs, agreed to participate. In each establishment, simultaneous single measurements of atmospheric nicotine, particulate matter (10 microm; PM10) and carbon dioxide (CO2) levels were measured in a general use area and in a designated "no smoking" area during times of normal operation, together with the levels in outdoor air (PM10 and CO2 only). Analyses were made of these data to assess the extent to which persons using the "no smoking" areas were protected from exposure to ETS. RESULTS: By comparison with levels in general use areas, nicotine and particulate matter levels were significantly less in the "no smoking" areas, but were still readily detectable at higher than ambient levels. For nicotine, mean (SD) levels were 100.5 (45.3) microg/m3 in the areas where smoking occurred and 41.3 (16.1) microg/m3 in the "no smoking" areas. Corresponding PM10 levels were 460 (196) microg/m3 and 210 (210) microg/m3, while outdoor levels were 61 (23) microg/m3. The reduction in pollutants achieved through a separate room being designated "no smoking" was only marginally better than the reduction achieved when a "no smoking" area was contiguous with a smoking area. CO2 levels were relatively uninformative. CONCLUSION: Provision of designated "no smoking" areas in licensed (gaming) clubs in New South Wales, Australia, provides, at best, partial protection from ETS-typically about a 50% reduction in exposure. The protection afforded is less than users might reasonably have understood and is not comparable with protection afforded by prohibiting smoking on the premises.

Air Pollutants↗
PubMed2005

Philip Morris toxicological experiments with fresh sidestream smoke: more toxic than mainstream smoke.

BACKGROUND: Exposure to secondhand smoke causes lung cancer; however, there are little data in the open literature on the in vivo toxicology of fresh sidestream cigarette smoke to guide the debate about smoke-free workplaces and public places. OBJECTIVE: To investigate the unpublished in vivo research on sidestream cigarette smoke done by Philip Morris Tobacco Company during the 1980s at its Institut für Biologische Forschung (INBIFO). METHODS: Analysis of internal tobacco industry documents now available at the University of California San Francisco Legacy Tobacco Documents Library and other websites. RESULTS: Inhaled fresh sidestream cigarette smoke is approximately four times more toxic per gram total particulate matter (TPM) than mainstream cigarette smoke. Sidestream condensate is approximately three times more toxic per gram and two to six times more tumourigenic per gram than mainstream condensate by dermal application. The gas/vapour phase of sidestream smoke is responsible for most of the sensory irritation and respiratory tract epithelium damage. Fresh sidestream smoke inhibits normal weight gain in developing animals. In a 21 day exposure, fresh sidestream smoke can cause damage to the respiratory epithelium at concentrations of 2 microg/l TPM. Damage to the respiratory epithelium increases with longer exposures. The toxicity of whole sidestream smoke is higher than the sum of the toxicities of its major constituents. CONCLUSION: Fresh sidestream smoke at concentrations commonly encountered indoors is well above a 2 microg/m3 reference concentration (the level at which acute effects are unlikely to occur), calculated from the results of the INBIFO studies, that defines acute toxicity to humans. Smoke-free public places and workplaces are the only practical way to protect the public health from the toxins in sidestream smoke.

Air Pollutants↗
PubMed1999

Health effects of passive smoking-10: Summary of effects of parental smoking on the respiratory health of children and implications for research.

BACKGROUND: Two recent reviews have assessed the effect of parental smoking on respiratory disease in children. METHODS: The results of the systematic quantitative review published as a series in Thorax are summarised and brought up to date by considering papers appearing on Embase or Medline up to June 1998. The findings are compared with those of the review published recently by the Californian Environmental Protection Agency (EPA). Areas requiring further research are identified. RESULTS: Overall there is a very consistent picture with odds ratios for respiratory illnesses and symptoms and middle ear disease of between 1.2 and 1.6 for either parent smoking, the odds usually being higher in pre-school than in school aged children. For sudden infant death syndrome the odds ratio for maternal smoking is about 2. Significant effects from paternal smoking suggest a role for postnatal exposure to environmental tobacco smoke. Recent publications do not lead us to alter the conclusions of our earlier reviews. While essentially narrative rather than systematic and quantitative, the findings of the Californian EPA review are broadly similar. In addition they have reviewed studies of the effects of environmental tobacco smoke on children with cystic fibrosis and conclude from the limited evidence that there is a strong case for a relationship between parental smoking and admissions to hospital. They also review data from adults of the effects of acute exposure to environmental tobacco smoke under laboratory conditions which suggest acute effects on spirometric parameters rather than on bronchial hyperresponsiveness. It seems likely that such effects are also present in children. CONCLUSIONS: Substantial benefits to children would arise if parents stopped smoking after birth, even if the mother smoked during pregnancy. Policies need to be developed which reduce smoking amongst parents and protect infants and young children from exposure to environmental tobacco smoke. The weight of evidence is such that new prevalence studies are no longer justified. What are needed are studies which allow comparison of the effects of critical periods of exposure to cigarette smoke, particularly in utero, early infancy, and later childhood. Where longitudinal studies are carried out they should be analysed to look at the way in which changes in exposure are related to changes in outcome. Better still would be studies demonstrating reversibility of adverse effects, especially in asthmatic subjects or children with cystic fibrosis.

Adult↗
PubMed2004

[Smoking cessation with ear acupuncture. Descriptive study on patients after a smoking cessation treatment with ear acupuncture].

BACKGROUND: In complementary medicine literature studies on long-term observation of one of its methods are rare. OBJECTIVE: The present study is an evaluation of the smoking behavior of patients treated with ear acupuncture for smoking cessation. Additionally we investigated factors that favor or impede smoking cessation. PATIENTS AND METHODS: 249 patients who had undergone ear acupuncture for smoking cessation between 1985 and 1998 in a practice in Aarau (Switzerland) were asked before the first treatment to fill in a form regarding their smoking behavior and retrospectively in autumn 1998 a questionnaire regarding the success of therapy. Ear acupuncture treatment consisted of 2 consultations at an interval of 10 days. The responder rate was 53.8% (134 questionnaires were returned). Finally the data of 126 persons could be evaluated. RESULTS: The Kaplan Meier analysis of the abstinence time yielded a one-year success rate of 41.1%. Men gave up smoking more easily than women. Start of smoking as well as start of treatment between the age of 20 and 40 years were favorable conditions for smoking cessation. People who had smoked 20 cigarettes or more per day before treatment profited the best. For people who smoked as a way of passing the time or because of tediousness it was easier to stop smoking than for people smoking because of nervousness. People living in a non-smoker household were able to stop smoking significantly easier than persons living in a smoker household. CONCLUSIONS: With a one-year success rate of 41.1% ear acupuncture is a competitive alternative to orthodox medicine withdrawal methods. Acupuncture treatment can be applied and adapted individually, furthermore it is economical and without side effects.

Acupuncture, Ear↗
PubMed2003

Diagnosis of airflow limitation combined with smoking cessation advice increases stop-smoking rate.

OBJECTIVES: To assess how the diagnosis of airflow limitation (AL) combined with advice to stop smoking in middle-aged smokers influence the smoking cessation rate and to identify predictors of successful outcome. DESIGN: Prospective, single-center, comparative study of the effects of smoking intervention in smokers with diagnosed AL and in smokers with normal lung function (NLF). SETTING: University hospital, out-patient clinic. PARTICIPANTS: Of 659 smokers participating in a population spirometric screening for COPD combined with smoking cessation advice, 558 (AL, 297 smokers; NLF, 261 smokers) were invited for a follow-up after 1 year. INTERVENTION: At follow-up, spirometry was repeated and smoking status was assessed. Nonsmoking status was validated with carbon monoxide measurements in exhaled air. Patients who did not come for the follow-up visit were considered to be smokers. RESULTS: Of 558 smokers invited, 368 (66%) presented for the follow-up visit. All had tried to reduce their smoking habit. The number of cigarettes smoked per day (cpd) at 1 year was - 5.2 (p < 0.01) in patients with AL and - 2.7 (not significant [NS]) in those with NLF. The 1-year cessation rate in smokers with AL was 10.1% vs 8.4% in smokers with NLF (NS). After stratifying the patients according to AL severity, the highest cessation rate was observed in smokers with moderate and severe AL (16.5%) compared to smokers with mild AL (6.4%; p < 0.001) and smokers with NLF (8.4%; p < 0.05). In a univariate analysis, the cessation of smoking was correlated with older age (p < 0.001), later age when starting smoking (p < 0.005), lower tobacco exposure (in pack-years; p < 0.01), fewer cpd (p < 0.001), and lower lung function (p < 0.05). No interaction effect was observed for any of the studied variables using two-way analysis of variance. In a stepwise logistic regression analysis, age (p < 0.001), tobacco exposure (in pack-years; p < 0.001), and FEV(1) percent predicted (p < 0.01) proved to be significant predictors of success in stopping smoking. CONCLUSION: All smokers, irrespective of their lung function, tried to modify their habit as the result of screening for COPD combined with smoking cessation advice. The diagnosis of AL motivated smokers to attempt to quit smoking. Older age, lower tobacco exposure, and lower lung function were the predictors of success in quitting smoking.

Age Factors↗
PubMed1997

The behavior of amidolytic factor VII in smoking and non-smoking pregnant women in relation to their gestational age.

OBJECTIVE: Aim of the study was to assess the behavior of factor VII by commercial amidolytic assay in smoking and non-smoking pregnant women, and to compare this with the earlier reported factor VII:C levels during pregnancy and to discuss the role of F VII:Am with regard to thromboembolic complication in smoking pregnant women. METHODS: Blood samples were obtained for 75 non-smoking pregnant women and 109 smoking pregnant women. For the chromogenic determination of F VII:Am a COA-Set F VII test kit from Kabi Vitrum was used. Correlations were calculated by the Spearman rank method. The Mann-Whitney-U test was used for the statistical comparison of the median values of the smoking and non-smoking groups. RESULTS: Both the smoking and non-smoking group displayed a significant increase of F VII:Am with gestational age (r=0.53; p<0.0001 for smokers and r=0.55; p=0.005 for non-smokers). The median concentration of F VII:Am was significantly higher in stage 3 (226%-211%) and stage 4 (262%-230%) in the smoking group. CONCLUSION: As elevated F VII:C levels have been described to be a risk factor for thrombotic events, the even higher than normally already enhanced plasma levels of FVII:Am in smoking pregnant women may indicate an additional risk for both thrombosis in the pregnant and for an increased fetal morbidity and even mortality caused by thrombotic processes in the uteroplacental vasculature. The results from the present study might be an extra argument to advise pregnant women not to smoke or to quit smoking during pregnancy.

Blood Coagulation↗
PubMed2006

Smoking in film and impact on adolescent smoking: with special reference to European adolescents.

This review examines the evidence supporting an association between seeing smoking depictions in movies and adolescent smoking. The portrayal of tobacco use is common in movies and often modeled by movie stars who, from a social influences standpoint, should be powerful behavior change agents. The results of studies assessing audience responses to tobacco portrayal in movies are remarkably consistent in showing a moderate to strong association between seeing movie smoking and more positive attitudes toward smoking and adolescent smoking initiation. The population-based data include cross sectional samples from different regions of the United States, all supporting a movie smoking-teen smoking link. The 2 published longitudinal studies show an independent link between exposure to movie smoking at baseline and initiation in the future, with estimates of the effect size being remarkably consistent with their cross-sectional counterparts. Experimental research adds support by showing that scene depictions of smoking enhance positive views of smokers and increase intent to smoke in the future. Taken as a whole, this rich research base provides very strong support for the notion that movie smoking plays a role in smoking initiation among adolescents that warrants action at the individual and societal level. A major gap in our understanding is the impact of Hollywood movies on adolescents outside the United States. There is a real need for studies to be conducted in European and other populations to better understand the global reach of smoking in American film, since over half of box office revenues come from outside the United States.

Adolescent↗
PubMed1996

The effect of cigarette-smoking on cardiovascular risk factors: a study of monozygotic twins discordant for smoking.

The association of cigarette smoking with the development of occlusive vascular disease is firmly established. Unfavourable changes in a series of variables held independent risk factors for the development of vascular lesions (HDL-cholesterol, haematocrit, white blood cell count, fibrinogen and plasminogen activator inhibitor-1 (PAI-1)) are thought to be directly influenced by cigarette smoking. However, the role played by the genotype in the effect of smoking on the above parameters has not been investigated. To control the genotype, we studied the relationship between cigarette smoking and a series of cardiovascular risk factors in 27 monozygotic twin pairs (7 male and 20 female pairs, mean age +/- SD: 47.4 +/- 12.9 yrs) with a life-long discordance for smoking. Smoking twins had a life-long dose of smoking (Brickman index) of 287.3 +/- 241.5. Body mass index, blood pressure, haematocrit, haemoglobin and red blood cell counts, total cholesterol levels and the acute phase reactants alpha 1-acid glycoprotein and C-reactive protein were similar in smokers and non-smokers. Triglyceride was higher by 12.6% (9.5-35%, 95% confidence interval, p = 0.02) and HDL-cholesterol lower by 7.5% (0.2-15%, p = 0.04) in the smoking co-twins, who also had 8.4% (-0.2-17%, p = 0.06) higher white blood cell counts and 4.1% (1.2-7%, p < 0.01) larger mean platelet volume. There was no significant difference in clottable fibrinogen (by two methods) or in the activity of plasminogen activator inhibitor-1 between the two groups, nor was the within-pair difference in these parameters related to the smoking dose. Echo-doppler examination of the carotid arteries of 24 twin pairs showed mostly minor atherosclerotic lesions in 46% and 42% of the smoking and non-smoking co-twins. After adjustment for age, systolic blood pressure and platelet count and volume were the only variables significantly associated to the presence of vascular lesions. Cigarette smoking is associated with an atherogenic lipid profile and with changes in platelets and white cells potentially reflecting endothelial cell damage. When controlling the genotype, fibrinogen and PAI-1 activity levels did not seem directly influenced by cigarette smoking.

Adult↗