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PubMed2005

Intensity of smoking and smoking cessation in relation to risk of cataract extraction: a prospective study of women.

The authors investigated the association of smoking and smoking cessation with the incidence of cataract extraction in a population-based prospective cohort study. A total of 34,595 women aged 49-83 years in the Swedish Mammography Cohort were followed from September 1997 through June 2002. Information on smoking, diet, and other lifestyle factors was collected through a self-administered questionnaire. A total of 2,128 cases of age-related cataract extraction were identified. Relative risks were estimated as rate ratios using Cox proportional hazards models. The authors observed a significant dose-response association between intensity of smoking and risk of cataract extraction (among current smokers, p for trend = 0.02; among past smokers, p for trend = 0.0002). After cessation of smoking, the risk decreased with time. Among women with a moderate lifetime smoking intensity (6-10 cigarettes/day), the relative risk was not significantly different from the risk among never smokers 10 years after smoking cessation. Among women who had smoked more intensively (>10 cigarettes/day), after 20 years of nonsmoking the increased risk became small and no longer statistically significant in comparison with never smokers (for trend over time, p < 0.0001). This prospective study confirmed smoking as a risk factor for cataract, with a dose response for smoking intensity. Smoking cessation predicts reduced risk over time, but a longer period of time is needed with a higher smoking intensity.

Aged↗
PubMed1983

Cigarette smoking and drug use in schoolchildren: IV--factors associated with changes in smoking behaviour.

Factors associated with changes in the smoking behaviour of approximately 6000 schoolchildren (two cohorts aged between 10 and 12 years in 1979) over 12 months are described. They were measured twice as part of a randomized controlled trial of a smoking prevention programme. Four groups were defined: (a) those who became smokers (adopters); (b) those who remained non-smokers; (c) those who became non-smokers (quitters), and, (d) those who remained smokers. Personal and social variables were ordered using a logistic regression model according to the strength of their association with adopting and quitting smoking. Factors distinguishing adopters from children who remained nonsmokers were, being a member of the older cohort, having friends who smoke, having siblings who smoke, approving of cigarette advertising and having a relatively large amount of money to spend each week. Factors distinguishing quitters from children who continued to smoke were, having siblings who do not smoke, being a member of the younger cohort, disapproving of cigarette advertising and having a relatively small amount of money to spend each week. Initial attitude scores were indicative of future smoking behaviour and where smoking behaviour changed, attitudes also changed so that the two remained congruent. The younger cohort improved their knowledge of smoking hazards over the year irrespective of their smoking behaviour. The older cohort showed significant differences in knowledge which were dependent upon smoking category, with 1980 smokers having lower knowledge scores than non-smokers and showing an apparent decrement in their previous knowledge.

Attitude↗
PubMed1989

Nottingham mothers stop smoking project -- baseline survey of smoking in pregnancy.

In the largest survey of smoking in pregnancy to date in the United Kingdom, 3882 women attending the two antenatal clinics in Nottingham during July and August 1986, were asked about their smoking habits. Thirty-seven per cent of pregnant women were smoking and only one in four of these was successful at stopping at some point during pregnancy. However, 55 per cent of the mothers who smoked at the start of pregnancy claimed to smoke less during pregnancy. No change was reported in the habits of one-quarter of the mothers who smoked during pregnancy and this proportion may represent an 'irreducible minimum'. Mothers were more likely to continue to smoke if younger (14-20 years), single, living with a partner who smoked, who left school at 16 years and were from manual working families. Those who succeeded in giving up smoking during pregnancy were more likely to be from professional and managerial families. Antenatal booklets about the dangers of smoking were the source of information cited most frequently. Half of the smoking mothers claimed not to have received advice from their family practitioners about the hazards of smoking nor information about how to give up the habit. Even fewer received such advice from hospital doctors, or midwives. This represents a major challenge to professional training in health education.

Adolescent↗
PubMed2000

The effect of cigarette smoking and smoking cessation on spinal fusion.

STUDY DESIGN: The effect of cigarette smoking and smoking cessation on spinal fusion was studied in a retrospective review of 357 patients who had undergone instrumented spinal fusion. OBJECTIVE: To document the widely assumed but unreported benefit of cigarette smoking cessation on fusion rate and clinical outcome after spinal fusion surgery. BACKGROUND DATA: Cigarette smoking has been shown to inhibit lumbar spinal fusion and to adversely effect outcome in treatment of lumbar spinal disorders. Prior reports have compared smokers and nonsmokers, as opposed to comparing smokers and quitters. METHODS: This study retrospectively identified 357 patients who underwent a posterior instrumented fusion at either L4-L5 or L4-S1 between 1992 and 1996. Analysis of the medical record and follow-up telephone surveys were conducted. Clinical outcome and fusion status was analyzed in relation to preoperative and postoperative smoking parameters. RESULTS: In this study, the nonunion rate was 14.2% for nonsmokers and 26.5% for patients who continued to smoke after surgery (P < 0.05). Patients who quit smoking after surgery for longer than 6 months had a nonunion rate of 17.1%. The nonunion rate was not significantly affected by either the quantity that a patient smoked before surgery or the duration of preoperative smoking abatement. Return-to-work was achieved in 71% of nonsmokers, 53% of nonquitters, and 75% of patients who quit smoking for more than 6 months after surgery. DISCUSSION: These results validate the hypothetical assumption that postoperative smoking cessation helps to reverse the impact of cigarette smoking on outcome after spinal fusion.

Adult↗
PubMed1998

Smoking prevalence and risk factors for smoking in a population of United States Air Force basic trainees.

OBJECTIVE: To provide a comprehensive assessment of smoking prevalence and risks for smoking in an entire population of United States Air Force (USAF) military basic trainees (n = 32,144). DESIGN: Population-based survey with every individual entering the USAF enlisted force from August 1995 to August 1996. SETTING: USAF Basic Military Training (BMT) facility at Lackland Air Force Base, Texas. All trainees were assessed during the first week of BMT. MAIN OUTCOME MEASURES: A 53-item questionnaire was developed to assess four domains: demographics, smoking history, risk factors for smoking, and other health behaviours. RESULTS: Approximately 32% of the trainees smoked regularly before basic training and a small percentage of the trainees (7.6%) described themselves as ex-smokers. Men, Euro-Americans, and those from lower educational backgrounds were more likely to smoke than other trainees. On average, smokers had smoked for approximately four years and had low nicotine dependence scores. Individuals who had smoked before BMT were more likely to use other drugs (such as alcohol, binge drinking, smokeless tobacco), and were less physically active than never-smokers. These findings were particularly strong for those who smoked up to basic training but were also evident for ex-smokers. CONCLUSIONS: Smoking is a prevalent risk factor among individuals entering the USAF. Furthermore, smoking was related to other risk factors believed to lower military readiness, including alcohol use and decreased physical activity. Comprehensive tobacco control policies aimed at reducing smoking among military trainees are needed.

Adult↗
PubMed1998

Exposure of young infants to environmental tobacco smoke: breast-feeding among smoking mothers.

OBJECTIVES: This study examined the degree to which breast-feeding and cigarette smoking by mothers and smoking by other household members contribute to the exposure of infants to the products of tobacco smoke. METHODS: The subjects were 330 mother-infant pairs derived from a cohort of 1000 pairs enrolled in a longitudinal study of the pulmonary effects of prenatal and postnatal smoking. The main outcome measure was corrected urinary cotinine levels. RESULTS: Urinary cotinine levels were 10-fold higher in breast-fed infants of smoking mothers than among bottle-fed infants of smoking mothers. Among infants of nonsmoking mothers, urine cotinine levels were significantly increased in infants living in homes with other smokers; in this group there was no significant difference between bottle-fed and breast-fed infants. Infants whose mothers smoked in the same room as the infant had only nonsignificant increases in cotinine levels compared with infants whose mothers restricted their smoking to other rooms. CONCLUSIONS: Breast-fed infants of smoking mothers have urine cotinine levels 10-fold higher than bottle-fed infants whose mothers smoke, suggesting that breast-feeding, rather than direct inhalation of environmental tobacco smoke, is the primary determinant of cotinine levels in infants whose mothers smoke.

Bottle Feeding↗
PubMed2000

Awareness of the harmful effects of smoking and views on smoking cessation intervention among Japanese medical students.

OBJECTIVE: To clarify attitudes toward smoking, and views on smoking intervention among medical students, as well as to teach them the harmful effects of smoking. SUBJECTS AND METHODS: We carried out an anonymous questionnaire among 2nd and 5th year Japanese medical students and 1,137 of them responded. RESULTS: Smoking prevalence was 25.1% in men and 8.8% in women in the 2nd year and 43.1% and 9.3%, respectively, in the 5th year. Most respondents thought smoking is harmful to health, but smokers were more likely to think it is not so harmful. In both groups, 97% of the respondents knew lung cancer was related to smoking. Apart from this, knowledge of smoking-related diseases (pulmonary emphysema, coronary heart disease, peptic ulcer, and neonatal death) increased by the 5th year but the rates of recognition were generally less than 50%. Many of them learned about the deleterious effects mainly at places other than medical class (80.2% in the 2nd, 44.9% in the 5th year). About 90% intended to perform smoking intervention in the future, but only one-third were actively interested. More than 70% of the respondents thought that doctors should carry out smoking cessation advice depending on the disease, while the rate of those who thought so irrespective of the disease did not reach 20%. Smokers thought less actively about smoking intervention than current nonsmokers. CONCLUSION: The awareness of the harmful effects of smoking and intention to perform smoking intervention in the future as doctors seemed unsatisfactory among Japanese medical students.

Adult↗
PubMedDate not supplied

Passive smoking in asthmatic children: effect of a "smoke-free house" measured by urinary cotinine levels.

Environmental tobacco smoke (ETS) decreases pulmonary function and increases both airway reactivity and frequency of child asthma exacerbations. True exposure is related not only to parents smoking and to the number of cigarettes that they smoke, but also to involuntary smoking in public places. The aim of this study was to evaluate, by measuring urinary cotinine levels, the exposure to ETS in asthmatic children and the contribution of unapparent smoke exposure. Twenty asthmatic children (aged 7-12 years) were evaluated on the 1st day (TO) and after a week (T1) in a "smoke-free house." The mean level of urinary cotinine in children was 15.8 +/- 2.7 ng/mg of creatinine at TO and 4.2 +/- 0.6 ng/mg of creatinine at T1 (p < 0.0001). The urinary cotinine concentrations were higher in children living with smoking parents (21.8 +/- 3.4 ng/mg creatinine) compared with children not exposed to parental smoke (6.8 +/- 3.0 ng/mg creatinine; p = 0.017). The number of cigarettes smoked by parents correlates with the urinary cotinine levels (p = 0.005; r = 0.64). Urinary cotinine levels significantly decreased after the avoidance of ETS in children exposed to parental smoke (21.8 +/- 3.4 ng/mg at TO; 5.0 +/- 0.8 ng/mg at T1; p < 0.001) and also in children whose parents declared to be nonsmokers (6.8 +/- 1.2 ng/mg at TO; 3.0 +/- 0.8 ng/mg at T1; p = 0.006). Our data confirm the widespread indirect and undetected tobacco smoke exposure in children with chronic asthma and the relevance of an evaluation with an objective method of the exposure to second-hand smoke.

Asthma↗
PubMed2006

Employee attitudes and smoking behavior at the City of Hope National Medical Center smoke-free campus.

Since 1989, City of Hope National Medical Center (COH), located in Duarte, California, and a member of the National Comprehensive Cancer Network, has prohibited smoking anywhere on the 100-acre campus. Because little published information is available on smoke-free campuses (SFCs), we investigated the attitudes of COH employees toward the SFC and attempted to answer the question of whether a difference in employee smoking behavior occurred and was attributable to the SFC policy. An anonymous survey was sent to all 2787 campus employees using both Web-based data entry and scannable paper forms. Employees with network access were contacted by e-mail and those without computers were contacted in person. Respondents were asked questions regarding their attitudes toward the SFC and about their smoking history and current smoking behavior. A total of 1356 responses (48.7%) were received. One hundred (7.4%) respondents were current smokers, 242 (17.8%) were ex-smokers, and 1014 (74.8%) were nonsmokers. Smokers and ex-smokers smoked a mean of 2.4 fewer cigarettes (95% CI, 1.8 to 3.1; P < .0001) on workdays than on days off, with evidence of a small amount of compensatory smoking (one cigarette per day). Of the smoking employees, 61.6% believed that the SFC reduced their cigarette consumption, and 42.2% quit smoking while employed at COH between 1989 and 2002. Of all respondents, 92.6% supported the COH SFC policy. High acceptance was consistent across gender, ethnicity, job type, and educational level. COH's SFC policy is strongly supported by employees and may decrease cigarette consumption and facilitate smoking cessation among smoking employees. This information may be useful to NCCN and other medical centers in assessing current and planning future campus smoking policies.

Academic Medical Centers↗
PubMed2002

[Change in smoking behavior and long-term smoking abstinence among patients with stomach or head and neck cancer admitted to a cancer center].

PURPOSE: This study was conducted to address change in smoking behavior of cancer patients when admitted to a cancer center, and elucidate factors associated with long-term smoking abstinence after discharge. METHODS: The subjects were 97 patients with stomach cancer and 93 with head and neck cancer (cancer in the oral cavity, pharynx and/or larynx that did not require total laryngectomy) who were current smokers at the time of first visit to a cancer center. In order to obtain detailed information on their smoking behavior, a self-administered questionnaire was mailed to each patient at least 18 months after the patient was discharged. Seventy-three percent (138/190) of the subjects returned the completed questionnaire by mail. RESULTS: The smoking cessation rates at five different time points, namely, 1) one day before admission, 2) the first day of admission, 3) the last day of admission, 4) one day after discharge, and 5) at the time the patient received the questionnaire, indicating long-term smoking abstinence after discharge, were 10.4%, 32.6%, 71.9%, 40.0% and 51.0%, respectively. Multivariate logistic regression analysis revealed that patients who had stopped smoking by the first day of admission had a significantly higher probability of long-term smoking abstinence than their counterparts who smoked up to the last day of admission. The patients who received doctors' and/or nurses' advice for smoking cessation at our medical center did not have significantly higher probability of long-term smoking abstinence than those who did not receive it. CONCLUSION: With patients suffering from stomach or head and neck cancer admitted to a cancer center, multivariate analysis indicated that smoking behavior in the pre-admission period influences long-term smoking abstinence after discharge.

Behaviorism↗
PubMed2004

Comparative socio-cultural analysis of smoking behavior and difficulty of quitting smoking in Japan and Thailand.

OBJECTIVE: Although education for smoking cessation is being conducted in Asian countries, the prevalence of smoking is still high. The present study was designed to clarify differences in the socio-cultural background in Japan and Thailand. METHODS: Cross-sectional study. The Japan survey was conducted in Kanagawa and the Thailand survey in Suphanburi. Questionnaires written in English were translated into each language. The subjects were out-patients of community hospitals (331 males and 353 females in Japan and 293 males and 288 females in Thailand). RESULTS: The prevalence of smoking was found to be higher in Thailand than in Japan for males but almost the same for females. A higher percentage of the subjects quit smoking in Japan than in Thailand. The motive for quitting smoking was "awareness of the harmful effects of smoking" in both countries, but "told by others to quit smoking" was also often encountered in Thailand. The method of quitting was most frequently "suppress the urge to smoke by will power" in both countries. Nicotine replacement therapy is not well known yet in either country. CONCLUSION: Smoking behavior was different although the difficulty of quitting smoking was common to both countries. The prevalence of smoking in younger males and females was established to be higher in Japan, and social and environmental regulations for quitting smoking were effective in Thailand. It suggests that such regulations should be made stricter in Japan. Enlightenment by providing knowledge may be particularly useful in Thailand.

Adult↗
PubMed2005

[Smoking-related biological alterations in women: a way to start talking about smoking. The internist's point a view: the clinical biologist's point of view].

Besides biological markers such as cotinine, CO, and thiocyanate, other biological parameters are altered during pregnancy in women who smoke. Smoking women generally have a high white cell count which is related in part to pregnancy and in part to smoking but independently of other conditions. The mean corpuscular volume is increased, even in the absence of folate deficiency frequent in smoking pregnant women. The platelet count is higher than in the non-smoking mothers and the physiological pregnancy-related hyperaggregability is increased. The hypercoagulability status during pregnancy does not appear to be worsened by smoking but is insufficiently counterbalanced by fibrolysis which is less active in the smoking pregnant woman. These factors increase the risk of venous thrombosis which remains one of the main factors of pregnancy-related mortality. There are also smoking-related lipid metabolism disorders which appear independently of the pregnancy-related variations: increased total cholesterol, LDL cholesterol, and triglycerides and decreased HDL cholesterol. Combined, these factors can have an effect on the arterial walls. Vitamin levels are also lower in smoking mothers compared with their non-smoking counterparts. Levels of vitamins C, A, B12 and folates are decreased. Finding these anomalies during pregnancy in smoking mothers can be a useful mean of inciting them to stop smoking.

Biology↗
PubMed2002

Effect of smoke-free workplaces on smoking behaviour: systematic review.

OBJECTIVE: To quantify the effects of smoke-free workplaces on smoking in employees and compare these effects to those achieved through tax increases. DESIGN: Systematic review with a random effects meta-analysis. STUDY SELECTION: 26 studies on the effects of smoke-free workplaces. SETTING: Workplaces in the United States, Australia, Canada, and Germany. PARTICIPANTS: Employees in unrestricted and totally smoke-free workplaces. MAIN OUTCOME MEASURES: Daily cigarette consumption (per smoker and per employee) and smoking prevalence. RESULTS: Totally smoke-free workplaces are associated with reductions in prevalence of smoking of 3.8% (95% confidence interval 2.8% to 4.7%) and 3.1 (2.4 to 3.8) fewer cigarettes smoked per day per continuing smoker. Combination of the effects of reduced prevalence and lower consumption per continuing smoker yields a mean reduction of 1.3 cigarettes per day per employee, which corresponds to a relative reduction of 29%. To achieve similar reductions the tax on a pack of cigarettes would have to increase from $0.76 to $3.05 (0.78 euro to 3.14 euro) in the United States and from 3.44 pounds sterling to 6.59 pounds sterling (5.32 euro to 10.20 euro) in the United Kingdom. If all workplaces became smoke-free, consumption per capita in the entire population would drop by 4.5% in the United States and 7.6% in the United Kingdom, costing the tobacco industry $1.7 billion and 310 million pounds sterling annually in lost sales. To achieve similar reductions tax per pack would have to increase to $1.11 and 4.26 pounds sterling. CONCLUSIONS: Smoke-free workplaces not only protect non-smokers from the dangers of passive smoking, they also encourage smokers to quit or to reduce consumption.

Adolescent↗