Validation of self reported smoking by serum cotinine measurement in a community-based study

The association of lone-motherhood with smoking cessation and relapse: prospective results from an Australian national study

The aims were to examine the association of lone-motherhood with smoking cessation and relapse, and to investigate the extent to which this association was accounted for by socioeconomic status (education, occupation, and income), social support, and mental health. We used data from 10 yearly waves (2001 to 2010) of the Household Income and Labour Dynamics in Australia (HILDA) survey. Response rate in the first wave was 66%. Logistic regression was used to examine the effect of lone-motherhood and other covariates on smoking cessation (n = 2,878) and relapse (n = 3,242). Results showed that the age-adjusted odds of smoking cessation were 32% smaller among lone mothers than partnered mothers (p = 0.004). The age-adjusted odds of relapse was 172% greater among lone mothers than partnered mothers (p < 0.001). We found that socioeconomic status, social support, and mental health account for some of the association of lone motherhood and cessation and relapse. While efforts to reduce the smoking prevalence among lone mothers should focus on their material deprivation, availability of social support, and addressing mental health issues, other factors unique to the lives of lone mothers also need to be taken into account. More research is needed to discover other factors that can explain the association of lone-motherhood and smoking behavior.

Health message framing effects on attitudes, intentions, and behavior: a meta-analytic review

BACKGROUND

Message framing has been an important focus in health communication research, yet prior meta-analyses found limited support for using framing to increase persuasiveness of health messages.

PURPOSE

This meta-analysis distinguished the outcomes used to assess the persuasive impact of framed messages (attitudes, intentions, or behavior).

METHODS

One hundred eighty-nine effect sizes were identified from 94 peer-reviewed, published studies which compared the persuasive impact of gain- and loss-framed messages.

RESULTS

Gain-framed messages were more likely than loss-framed messages to encourage prevention behaviors (r = 0.083, p = 0.002), particularly for skin cancer prevention, smoking cessation, and physical activity. No effect of framing was found when persuasion was assessed by attitudes/intentions or among studies encouraging detection.

CONCLUSIONS

Gain-framed messages appear to be more effective than loss-framed messages in promoting prevention behaviors. Research should examine the contexts in which loss-framed messages are most effective, and the processes that mediate the effects of framing on behavior.

Tobacco use, smoking quit rates, and socioeconomic patterning among men and women: a cross-sectional survey in rural Andhra Pradesh, India

BACKGROUND

Tobacco use is common in India and a majority of users are in rural areas. We examine tobacco use and smoking quit rates along gender and socioeconomic dimensions in rural Andhra Pradesh.

DESIGN AND METHODS

Data come from a cross-sectional survey. Markers of socioeconomic status (SES) were education, occupation, and income. Regression analyses were undertaken to examine determinants of current smoking, smoking quit rates, tobacco use by type (cigarettes, bidis, and chewing), and quantity consumed (number per day, pack-years).

RESULTS

The weighted prevalence of current smoking and tobacco chewing was higher in men (50.3%, 95% confidence interval, CI, 48.1-52.6 and 5.0%, 95% CI 4.1-5.9, respectively) compared with women (4.8%, 95% CI 3.9-5.7 and 1.0%, 95% CI 0.6-1.4, respectively) and higher among older age groups. The quit rate was higher in women (45.5%, 95% CI 38.7-52.2) compared to men (18.8%, 95% CI 16.7-20.9). Illiterate individuals were more likely to be current smokers of any type compared to those with secondary/higher education (odds ratio, OR, 3.25, 95% CI 2.54-4.16), although cigarette smoking was higher in men of high SES. Smoking quit rates were positively associated with SES (OR 2.56, 95% CI 1.76-3.71) for secondary/higher education vs. illiterates. Level of consumption increased with SES and those with secondary/higher education smoked an additional 1.93 (95% CI 1.08-2.77) cigarettes or bidis per day and had an additional 1.87 (95% CI 0.57-3.17) pack-years vs. illiterates.

CONCLUSIONS

The social gradients in cigarette smoking and level of consumption contrasted those for indigenous forms of tobacco (bidi smoking and chewing). International prevention and cessation initiatives designed at modifying Western-style cigarette usage will need to be tailored to the social context of rural Andhra Pradesh to effectively influence the use of cigarettes and equally harmful indigenous forms of tobacco.

Job strain and health-related lifestyle: findings from an individual-participant meta-analysis of 118,000 working adults

OBJECTIVES

We examined the associations of job strain, an indicator of work-related stress, with overall unhealthy and healthy lifestyles.

METHODS

We conducted a meta-analysis of individual-level data from 11 European studies (cross-sectional data: n = 118,701; longitudinal data: n = 43,971). We analyzed job strain as a set of binary (job strain vs no job strain) and categorical (high job strain, active job, passive job, and low job strain) variables. Factors used to define healthy and unhealthy lifestyles were body mass index, smoking, alcohol intake, and leisure-time physical activity.

RESULTS

Individuals with job strain were more likely than those with no job strain to have 4 unhealthy lifestyle factors (odds ratio [OR] = 1.25; 95% confidence interval [CI] = 1.12, 1.39) and less likely to have 4 healthy lifestyle factors (OR = 0.89; 95% CI = 0.80, 0.99). The odds of adopting a healthy lifestyle during study follow-up were lower among individuals with high job strain than among those with low job strain (OR = 0.88; 95% CI = 0.81, 0.96).

CONCLUSIONS

Work-related stress is associated with unhealthy lifestyles and the absence of stress is associated with healthy lifestyles, but longitudinal analyses suggest no straightforward cause-effect relationship between work-related stress and lifestyle.

Impact of smoking status on cardiovascular outcomes following percutaneous coronary intervention

BACKGROUND

Many military veterans in the United States with coronary artery disease continue to smoke despite undergoing percutaneous coronary intervention (PCI). Previous studies have described improved cardiovascular outcomes in smokers, the so-called "smokers' paradox." In this study, we examined the effects of smoking on cardiovascular outcomes following PCI.

HYPOTHESIS

Do patients who smoke have different post-PCI outcomes than nonsmokers?

METHODS

All patients who underwent PCI at a single US Veterans Administration hospital from 2004 to 2009 were followed. Outcomes of interest included myocardial infarction, unplanned coronary intervention, unplanned cardiac hospitalization, death, and a composite of events for 6 months after PCI. Changes in traditional risk factors were also assessed.

RESULTS

Unadjusted analysis revealed that in almost all categories, smokers had lower incidence of adverse events than nonsmokers. However, after adjusting for the older age of the nonsmokers, no favorable statistical trend toward smokers was seen. Significant improvement in blood pressure and lipid levels were seen in both groups.

CONCLUSIONS

After adjusting for differences in age, there did not appear to be any protective effect of smoking on cardiovascular outcomes following PCI. Smokers achieved similar degrees of risk factor optimization during the follow-up period as their nonsmoker counterparts. Aggressive efforts to decrease the prevalence of smoking must be maintained.

Educational inequalities in mortality in northern, mid and southern Italy and the contribution of smoking

BACKGROUND

Previous studies have shown that mortality inequalities are smaller in Italy than in most European countries. This may be due to the weak association between socioeconomic status and smoking in Italy. However, most published studies were based on data from a single city in northern Italy (Turin). In this study, we aimed to assess the size of mortality inequalities in Italy as a whole, their geographical pattern of variation within Italy, and the contribution of smoking to these inequalities.

METHODS

Participants in the National Health Interview Survey 1999-2000 were followed up for mortality until 31 December 2007. Using Cox regression, we computed the age-adjusted relative index of inequality (RII) for all-cause mortality with and without controlling for smoking status and intensity. Education was used as an indicator of socioeconomic status.

RESULTS

Among 72,762 individuals aged 30-74 years at baseline, 4092 died during the follow-up. The age-adjusted RII of mortality was 1.69 (95% CI 1.44 to 2.00) among men and 1.43 (95% CI 1.13 to 1.82) among women. Among men, inequalities were larger in both northern and southern regions than in the middle of the country, whereas among women they were larger in the south. After controlling for smoking RII decreased to 1.63 (95% CI 1.38 to 1.92) among men and increased to 1.54 (95% CI 1.21 to 1.96) among women. The geographical variation in mortality inequalities was not affected by smoking adjustment.

CONCLUSIONS

Mortality inequalities in Italy are smaller than in most European countries. This is due, among other factors, to the weak socioeconomic pattern of smoking over the past decades in Italy.

It is better to be a fat ex-smoker than a thin smoker: findings from the 1997-2004 National Health Interview Survey-National Death Index linkage study

OBJECTIVE

The aim of this research was to compare the risk of all-cause mortality and mortality from all cancers combined, lung cancer, respiratory diseases, cardiovascular diseases and diabetes mellitus between normal-weight smokers and overweight or obese ex-smokers.

METHODS

Data were from 1997 to 2004 National Health Interview Survey (with response rates ranging from 70% to 80%) which were linked to records in the National Death Index. Mortality follow-up was through 31 December 2006. The sample was limited to normal-weight smokers and overweight/obese ex-smokers 25 years of age and older (n=52,819). HR from Cox regression was computed to represent mortality effect.

RESULTS

Results showed that in both women and men, normal-weight smokers, relative to overweight or obese ex-smokers, had a higher risk of mortality from all causes combined, all cancers combined, lung cancer, cardiovascular and respiratory diseases. Among women, there was no difference in mortality risk from diabetes mellitus between normal-weight smokers and overweight or obese ex-smokers. Among men, there was some evidence that the risk of mortality was higher in obese ex-smokers than normal-weight smokers.

CONCLUSIONS

This article concludes that, overall, mortality risk is smaller in overweight or obese ex-smokers than normal-weight smokers. Smoking cessation interventions can tailor messages that highlight the greater reduction in mortality associated with quitting, compared with potential weight gain.

Research priorities for FCTC Articles 20, 21, and 22: surveillance/evaluation and information exchange

INTRODUCTION

Framework Convention on Tobacco Control (FCTC) Articles 20, 21, and 22 call for strong monitoring and reporting of tobacco use and factors influencing use and disease (Articles 20 and 21) and for collaboration among the Parties and relevant organizations to share resources, knowledge, and expertise on all relevant tobacco control strategies (Article 22).

METHODS

This paper provides background information and discusses research strategies that would strengthen these efforts and better inform the parties. By necessity, Articles 20 and 21 are discussed separately from Article 22, although 1 example that relates to both 20/21 and 22 is discussed at the end.

RESULTS

Twelve important research opportunities on surveillance and evaluation are recognized, along with 4 on collaboration. The authors believe that the 6 most important areas for research would study (a) possible underreporting of tobacco use among certain demographic groups in some countries, (b) measures of industry activities, (c) optimal sampling strategies, (d) sentinel surveillance, (e) networks of tobacco companies and their partners as they promote tobacco use and interfere with implementation of the FCTC, and (f) network/relationship factors that impact diffusion of knowledge and decision making on the implementation of the FCTC. In addition, we call for a review process of existing surveillance and evaluation strategies to coordinate activities to make optimal use of existing resources. This activity would involve networking as prescribed in Article 22.

CONCLUSIONS

Studies and activities such as these would facilitate control of the tobacco epidemic.

Factors associated with self-assessed increase in tobacco consumption among over-indebted individuals in Germany: a cross-sectional study

Background

Over-indebtedness is an increasing phenomenon in industrialised nations causing individual hardship and societal problems. Nonetheless, few studies have explored smoking among over-indebted individuals.

Methods

A cross-sectional survey (n=949) on retrospectively assessed changes in tobacco consumption was carried out in 2006 and 2007 among clients of 84 officially approved debt and insolvency counselling centres in Germany (response rate 39.7%). Logistic regressions were performed to explore factors associated with reports of increased smoking after onset of over-indebtedness.

Results

63% of all respondents stated daily or occasional tobacco consumption. Almost one fifth reported an increase in smoking after becoming over-indebted. Females were less likely to report increased smoking than men (aOR 0.66, 95% CI 0.44-0.99) whereas respondents who had been over-indebted for more than 10 years were more likely to report increased smoking than those who had been over-indebted for less than five years (aOR 1.66; 95%-CI 1.00-2.76). The odds of increased smoking were also elevated among those who reported that their families and friends had withdrawn from them as a consequence of their over-indebtedness (aOR 1.82; 95%-CI 1.06-3.14).

Conclusions

The study identifies over-indebted individuals and particularly over-indebted men as a high-risk group of smokers. Low levels of social embeddedness/support were associated with a further increase in smoking after becoming over-indebted. Given recent increases of over-indebtedness, the findings highlight the need to develop appropriate public health policies.

Relationship of smoking and/or passive exposure to tobacco smoke on the association between serum thyrotropin and body mass index in large groups of adolescents and children

BACKGROUND

Hypothyroidism may be a risk factor for obesity, because metabolic rates tend to be decreased in this disorder. Currently, it is under debate whether smoking may modify the association between hypothyroidism and obesity. Against this background, the aims of our study were to investigate whether there is an association between serum thyrotropin (TSH) and body mass index (BMI) in children and adolescents and whether smoking mediates this association.

METHODS

Data from 6435 children (ages 3-10) and 5918 adolescents (ages 11-17) from the "The German Health Interview and Examination Survey for Children and Adolescents" (KiGGS) were analyzed. Smoking status was classified into two categories: smokers and nonsmokers. A subject was classified as being exposed to environmental tobacco smoke (ETS) if someone in the parental home smoked more than 1 day a week. Serum TSH levels were measured with an ELISA method. Serum TSH levels were associated with BMI and obesity by multivariable linear regression stratified by smoking status and exposure to ETS.

RESULTS

In adolescents, there was an association between serum TSH levels and BMI, and it was stronger in smokers (β=0.62; 95% confidence interval [CI 0.38-0.85]) than in nonsmokers (β=0.18 [CI 0.09-0.28]). Likewise, it was stronger in adolescents exposed to ETS and adolescents not exposed to ETS. In children, who were either exposed or not exposed to ETS, there was an association between serum TSH levels and BMI. In them, however, the strength of this association was similar in those exposed and those not exposed to ETS.

CONCLUSIONS

Active and passive smoking may mediate the association between thyroid function and BMI in adolescents. In smoking adolescents, hypothyroidism may lead to an increase of the BMI, whereas this is not the case in nonsmoking adolescents.

Proximity to a tobacco store and smoking cessation: a cohort study

BACKGROUND

It is not clear whether the availability of tobacco affects the likelihood of smoking cessation. We examined whether the proximity to a tobacco store and the number of stores were associated with smoking cessation, and compared results for proximity variables based on walking and straight-line (as the crow flies) distance.

METHODS

The study population consisted of 8751 baseline smokers from the Finnish Public Sector study in 1997-2005. Smoking intensity (cigarettes/day) was determined at baseline and smoking cessation was determined from a follow-up survey in 2008-2009. Proximity was measured using straight-line and walking distance from home to the nearest tobacco store, and another exposure variable was the number of stores within 0.50 km from home. We calculated associations with log-binomial regression models, adjusting for individual-level and area-level confounders.

RESULTS

Of the participants, 3482 (39.8%) quit smoking during the follow-up (mean follow-up 5.5 years, SD 2.3 years). Among men who were moderate/heavy smokers at baseline and lived <0.50 km walking distance from the nearest tobacco store, the likelihood of smoking cessation was 27% (95% CI 12% to 40%) lower compared with those living ≥0.50 km from a store. Having even one store within 0.50 km walking distance from home decreased cessation in men who were moderate/heavy smokers by 37% (95% CI 19% to 51%). No decrease was found for men who were light smokers at baseline or for women.

CONCLUSIONS

Living within walking distance of a tobacco store reduced the likelihood of smoking cessation among men who were moderate/heavy smokers.

Changing trends in the prevalence and disparities of obesity and other cardiovascular disease risk factors in three racial/ethnic groups of USA adults

Objectives. To examine trends in the prevalence and disparities of traditional cardiovascular disease (CVD) risk factors among the major race/ethnic groups in the USA: non-Hispanic Whites (NHWs), non-Hispanic Blacks (NHBs), and Mexican Americans (MAs). Methods. We used cross-sectional trend analysis in women and men aged 25-84 years participating in the NHANES surveys, years 1988-1994 (n = 14,341) and 1999-2004 (n = 12,360). Results. The prevalence of obesity and hypertension increased significantly in NHW and NHB, both in men and women; NHB had the highest prevalence of obesity and hypertension in each time period. Diabetes prevalence showed a nonsignificant increasing trend in all groups and was higher in MA in both periods. Smoking significantly decreased in NHW men and NHB, the latter with the largest decline although the highest prevalence in each period; no changes were noted in MA, who had the lowest prevalence in both periods. Race/ethnic CVD risk factors disparities widened for obesity and hypercholesterolemia, remained unchanged for diabetes and hypertension, and narrowed for smoking. Conclusions. The increasing prevalence of obesity and hypertension underscores the need for better preventive measures, particularly in the NHB group that exhibits the worst trends. The decline in smoking rates may offset some of these unfavorable trends.

Tobacco smoking and solid organ transplantation

Smoking, both by donors and by recipients, has a major impact on outcomes after organ transplantation. Recipients of smokers' organs are at greater risk of death (lungs hazard ratio [HR], 1.36; heart HR, 1.8; and liver HR, 1.25), extended intensive care stays, and greater need for ventilation. Kidney function is significantly worse at 1 year after transplantation in recipients of grafts from smokers compared with nonsmokers. Clinicians must balance the use of such higher-risk organs with the consequences on waiting list mortality if the donor pool is reduced further by exclusion of such donors. Smoking by kidney transplant recipients significantly increases the risk of cardiovascular events (29.2% vs. 15.4%), renal fibrosis, rejection, and malignancy (HR, 2.56). Furthermore, liver recipients who smoke have higher rates of hepatic artery thrombosis, biliary complications, and malignancy (13% vs. 2%). Heart recipients with a smoking history have increased risk of developing coronary atherosclerosis (21.2% vs. 12.3%), graft dysfunction, and loss after transplantation. Self-reporting of smoking is commonplace but unreliable, which limits its use as a tool for selection of transplant candidates. Despite effective counseling and pharmacotherapy, recidivism rates after transplantation remain high (10-40%). Transplant services need to be more proactive in educating and implementing effective smoking cessation strategies to reduce rates of recidivism and the posttransplantation complications associated with smoking. The adverse impact of smoking by the recipient supports the requirement for a 6-month period of abstinence in lung recipients and cessation before other solid organs.

The use of financial incentives in promoting smoking cessation

OBJECTIVE

Cigarette smoking is the leading cause of preventable death in the United States and world. Despite the availability of numerous therapies for smoking cessation, additional efficacious interventions are greatly needed. We provide a narrative review of published studies evaluating financial incentives for smoking cessation and discuss the parameters important for ensuring the efficacy of incentive interventions for smoking cessation.

METHODS

Published studies that evaluated the impact of incentives to promote smoking cessation and included an appropriate control or comparison condition were identified and reviewed.

RESULTS

Incentives are efficacious for promoting smoking abstinence across the general population of smokers as well as substance abusers, adolescents, patients with pulmonary disease, patients with serious mental illness and other challenging subgroups. To develop and implement an effective incentive treatment for smoking, special attention should be paid to biochemical verification of smoking status, incentive magnitude and the schedule of incentive delivery.

CONCLUSION

Consistent with the extensive literature showing that incentives are effective in reducing illicit drug use, a large body of evidence supports their effectiveness in reducing smoking. Continued efforts are warranted to further develop and disseminate incentive-based treatments for smoking cessation across clinical settings and populations.

Trajectories of cigarette smoking in adulthood predict insomnia among women in late mid-life

OBJECTIVE

To examine the relationship between trajectories of cigarette smoking among a community sample of women (N=498) with insomnia in late mid-life.

METHODS

Participants were administered structured interviews at four time waves in adulthood, spanning approximately 25 years (mean ages=40, 43, 48, and 65 years). At each wave, data were collected on participants' cigarette smoking. At the most recent time wave, in late mid-life, participants reported on their insomnia (difficulty falling asleep, staying asleep, early morning wakening, and daytime consequences of these sleep problems).

RESULTS

Growth mixture modeling extracted four trajectory groups of cigarette smoking (from mean ages 40-65 years): chronic heavy smokers, moderate smokers, late quitters, and non-smokers. Multivariate logistic regression analysis then examined the relationship between participants' probabilities of trajectory group membership and insomnia in late mid-life, with controls for age, educational level, marital status, depressive symptoms, body mass index, and the number of health conditions. Compared with the non-smokers group, members of the chronic heavy smoking trajectory group were more likely to report insomnia at mean age 65 (Adjusted Odds Ratio=2.76; 95% confidence interval=1.10-6.92; p<0.05).

CONCLUSIONS

Smoking cessation programs and clinicians treating female patients in mid-life should be aware that chronic heavy smoking in adulthood is a significant risk factor for insomnia.

Young male daily smokers are nicotine dependent and experience several unsuccessful quit attempts

OBJECTIVE

Previous studies on smoking cessation have generally been conducted with adolescents or adults. Very little is known about the cessation attempts, their success, and/or use of pharmacological aids in young adult smokers who want to quit. The present study aimed to investigate quitting attempts in a group of both young male daily and occasional smokers.

DESIGN AND SUBJECTS

614 male smokers aged 18-26 years completed a standardized questionnaire about their smoking habits, quit attempts, and aids used in smoking cessation.

RESULTS

Nearly all daily smokers (95.3%, 95% CI 93.1-96.8) were nicotine addicted to some extend according to the standardized questionnaire, and the more addicted they were, the more often they had tried to quit (p = 0.025). Of the daily smokers, 55.6% (95% CI 51.3-59.9) had made quit attempts and 36.2% (95% CI 32.1-40.4) had used nicotine replacement therapy (NRT). In all, 34.1% (95% CI 25.2-44.3) of all occasional smokers reported having intended to quit but they had seldom made more than one attempt whereas 20.2% of daily smokers had made at least three attempts. The stronger the nicotine dependence in daily smokers was, the more likely the subject was to have attempted to use NRT (quite dependent 23.8% vs. totally dependent 48.9%) (p < 0.001).

CONCLUSIONS

A high proportion of young male daily smokers were nicotine addicted. Young smokers make many unsuccessful attempts to stop smoking using nicotine replacement therapy (NRT) on their own. A better availability of professional cessation services directed to young adult smokers is needed.

Association between smoking behavior patterns and chronic obstructive pulmonary disease: a long-term follow-up study among Finnish adults

Low-rate smoking patterns are common, but their pulmonary effects remain poorly known. The study hypothesis was that any level of daily smoking may cause chronic obstructive pulmonary disease (COPD). We investigated the association between longitudinal smoking patterns and COPD using logistic regressions and survival models adjusted for multiple covariates. Data from Finnish Twin Cohort surveys were used. Participants (n = 21,609) were grouped into categories describing 1981 smoking and change in smoking during 1975-1981. Light smoking was defined as < 5 cigarettes per day, moderate 5-19 cigarettes, and heavy ≥ 20 cigarettes per day. Finland's Social Insurance Institution provided data on inhaled anticholinergics purchases (1995-2008) and diagnoses entitling to special reimbursements (1981-2008). We defined COPD as regular anticholinergic use or special reimbursement eligibility for COPD, emphysema, or chronic bronchitis. COPD incidence was 2.5% (n = 528). Elevated disease risks were observed in former, moderate, and heavy smokers, in all who increased smoking, and in those who reduced from moderate to light smoking. Increased risk for anticholinergic use was found in former smokers, in constant light, moderate, and heavy smokers, and in increasers. Former, light, moderate, and heavy smoking in 1981 was associated with future development of disease. Our results demonstrate that all daily smoking patterns may impair pulmonary function.

Smoking, childhood IQ, and cognitive function in old age

OBJECTIVES

To examine the association between smoking history and cognitive function in old age, and whether it remains after controlling for childhood cognitive ability (IQ) and adult socioeconomic status (SES).

METHODS

In the Lothian Birth Cohort 1936 Study, 1080 men and women, who previously participated in a nationwide IQ-type test in childhood, were followed up at age 70. The associations between smoking history and age 70 IQ, general cognitive ability (g), processing speed, memory, and verbal ability were assessed.

RESULTS

Lower childhood IQ was associated with a higher risk of becoming a smoker and continuing to smoke in late life, and with reduced lung function (FEV1) in late life. Current smokers scored significantly lower than ex-smokers and never smokers on tests of age 70 IQ, general cognitive ability, and processing speed, but not memory or verbal ability. After controlling for childhood IQ and SES, current smoking at age 70 (but not pack years of smoking) was associated with impairments in general cognitive ability and processing speed.

CONCLUSION

Smoking in old age makes a small, independent contribution to cognitive performance in old age.

Job strain and tobacco smoking: an individual-participant data meta-analysis of 166,130 adults in 15 European studies

Background

Tobacco smoking is a major contributor to the public health burden and healthcare costs worldwide, but the determinants of smoking behaviours are poorly understood. We conducted a large individual-participant meta-analysis to examine the extent to which work-related stress, operationalised as job strain, is associated with tobacco smoking in working adults.

Methodology and Principal Findings

We analysed cross-sectional data from 15 European studies comprising 166 130 participants. Longitudinal data from six studies were used. Job strain and smoking were self-reported. Smoking was harmonised into three categories never, ex- and current. We modelled the cross-sectional associations using logistic regression and the results pooled in random effects meta-analyses. Mixed effects logistic regression was used to examine longitudinal associations. Of the 166 130 participants, 17% reported job strain, 42% were never smokers, 33% ex-smokers and 25% current smokers. In the analyses of the cross-sectional data, current smokers had higher odds of job strain than never-smokers (age, sex and socioeconomic position-adjusted odds ratio: 1.11, 95% confidence interval: 1.03, 1.18). Current smokers with job strain smoked, on average, three cigarettes per week more than current smokers without job strain. In the analyses of longitudinal data (1 to 9 years of follow-up), there was no clear evidence for longitudinal associations between job strain and taking up or quitting smoking.

Conclusions

Our findings show that smokers are slightly more likely than non-smokers to report work-related stress. In addition, smokers who reported work stress smoked, on average, slightly more cigarettes than stress-free smokers.

Implementation of workplace-based smoking cessation support activities and smoking cessation among employees: the Finnish Public Sector Study

OBJECTIVES

We investigated the relationship between implementation of workplace smoking cessation support activities and employee smoking cessation.

METHODS

In 2 cohort studies, participants were 6179 Finnish public-sector employees who self-reported as smokers at baseline in 2004 (study 1) or 2008 (study 2) and responded to follow-up surveys in 2008 (study 1; n=3298; response rate = 71%) or 2010 (study 2; n=2881; response rate=83%). Supervisors' reports were used to assess workplace smoking cessation support activities. We conducted multilevel logistic regression analyses to examine changes in smoking status.

RESULTS

After adjustment for sociodemographic characteristics, number of cigarettes smoked per day, work unit size, shift work, type of job contract, health status, and health behaviors, baseline smokers whose supervisors reported that the employing agency had offered pharmacological treatments or financial incentives were more likely than those in workplaces that did not offer such support to have quit smoking. In general, associations were stronger among moderate or heavy smokers (≥ 10 cigarettes/day) than among light smokers (<10 cigarettes/day).

CONCLUSIONS

Cessation activities offered by employers may encourage smokers, particularly moderate or heavy smokers, to quit smoking.

Physical activity and influenza-coded outpatient visits, a population-based cohort study

BACKGROUND

Although the benefits of physical activity in preventing chronic medical conditions are well established, its impacts on infectious diseases, and seasonal influenza in particular, are less clearly defined. We examined the association between physical activity and influenza-coded outpatient visits, as a proxy for influenza infection.

METHODOLOGY/PRINCIPAL FINDINGS

We conducted a cohort study of Ontario respondents to Statistics Canada's population health surveys over 12 influenza seasons. We assessed physical activity levels through survey responses, and influenza-coded physician office and emergency department visits through physician billing claims. We used logistic regression to estimate the risk of influenza-coded outpatient visits during influenza seasons. The cohort comprised 114,364 survey respondents who contributed 357,466 person-influenza seasons of observation. Compared to inactive individuals, moderately active (OR 0.83; 95% CI 0.74-0.94) and active (OR 0.87; 95% CI 0.77-0.98) individuals were less likely to experience an influenza-coded visit. Stratifying by age, the protective effect of physical activity remained significant for individuals <65 years (active OR 0.86; 95% CI 0.75-0.98, moderately active: OR 0.85; 95% CI 0.74-0.97) but not for individuals ≥ 65 years. The main limitations of this study were the use of influenza-coded outpatient visits rather than laboratory-confirmed influenza as the outcome measure, the reliance on self-report for assessing physical activity and various covariates, and the observational study design.

CONCLUSION/SIGNIFICANCE

Moderate to high amounts of physical activity may be associated with reduced risk of influenza for individuals <65 years. Future research should use laboratory-confirmed influenza outcomes to confirm the association between physical activity and influenza.

Concurrent use of cigarettes and smokeless tobacco among US males and females

BACKGROUND

The current study describes concurrent use of cigarettes and smokeless tobacco (CiST) among males and females and evaluates factors associated with CiST use.

METHODS

Cross-sectional data were drawn from the 2010 Behavioral Risk Factor Surveillance System (BRFSS). Weighted stratified analyses were performed to find associations between CiST use and sociodemographic factors by gender. CiST users were compared to three different tobacco use groups: nonusers, exclusive smokers, and exclusive ST users.

RESULTS

Younger age and heavy alcohol consumption were consistently associated with increased odds of CiST use among both males and females, and regardless of comparison group. Among males, education was inversely related to CiST use, and these findings were consistent in all three comparisons. Among women, those unable to work or out of work were more likely to be CiST users, which was consistent across comparisons. American Indian females had higher odds of CiST use than White females when nontobacco users or smokers were the comparison group.

CONCLUSION

This study identified sociodemographic characteristics associated with CiST use, and differences in these associations among women and men. Additionally, this study highlights the need to carefully consider what comparison groups should be used to examine factors associated with CiST use.

Social capital and smoking among Asian American men: an exploratory study

OBJECTIVES

We examined how different dimensions of social capital (i.e., family and friend connections, neighborhood and family cohesion, family conflict) were associated with smoking behavior among a nationally representative sample of Asian American men and whether the associations varied by ethnic group.

METHODS

The sample consisted of 998 adult Asian American men who participated in the National Latino and Asian American Survey from 2002 to 2003. We conducted weighted multivariate logistic regressions on data for the sample and for each of 4 ethnic subgroups (Chinese, Vietnamese, Filipino, and Other).

RESULTS

Vietnamese American men had the highest prevalence of current smoking; Chinese American men, the lowest. After controlling for sociodemographics, socioeconomic status, acculturation, and perceived discrimination, neighborhood cohesion was inversely associated with smoking among Asian American men, and family and friend connections and family cohesion were not. An exception was family cohesion, which was associated with increased odds of smoking among Filipino American men.

CONCLUSIONS

The relationship between social capital and smoking among Asian American men varied according to specific dimensions of social capital and was ethnicity specific. These findings highlight the need for smoking prevention and cessation interventions to take into consideration the heterogeneity that exists among Asian Americans.

Does the association between smoking and mortality differ by educational level?

Some researchers suggest that the effect of smoking on health depends on socioeconomic status; while others purport that the effect of smoking on health is similar across all social groups. This question of the interaction between smoking and socioeconomic status is important to an improved understanding of the role of smoking in the social gradient in mortality and morbidity. For this purpose, we examined whether educational level modifies the association between smoking and mortality. Information on smoking by age, gender and educational level was extracted from the Belgian Health Interview Surveys of 1997 and 2001. The mortality follow up of the survey respondents was reported until December 2010. A Poisson regression was used to estimate the hazard ratio of mortality for heavy smokers, light smokers, and former smokers compared with never smokers by educational level controlling for age and other confounders. Among men, we found lower hazard ratios in the lowest educational category compared with the intermediate and high-educated categories. For instance, for heavy smokers, the hazard ratios were 2.59 (1.18-5.70) for those with low levels of education, 4.03 (2.59-6.26) for those with intermediate levels of education and 3.78 (1.52-9.43) for the highly educated. However, the interaction between smoking and education was not statistically significant. For women, the hazard ratios were not significant for any educational category except for heavy smokers with intermediate levels of education. Also here the interaction was not statistically significant. Our results support the hypothesis that educational attainment does not substantially influence the association between smoking and mortality.

Maternal smoking during pregnancy and childhood obesity: results from the CESAR Study

Childhood obesity is a worldwide public health concern. Recent studies from high income countries have demonstrated associations between maternal smoking during pregnancy and children's excess body weight. We examine associations between maternal smoking during pregnancy and children's overweight or obesity, in six countries in the less affluent Central/Eastern European region. Questionnaire data were analysed, for 8,926 singleton children aged 9-12 years. Country-specific odds ratios for effects of maternal smoking during pregnancy on being overweight, and on obesity, were estimated using logistic regression. Heterogeneity between country-specific results, and mean effects (allowing for heterogeneity) were estimated. Positive associations between maternal smoking and overweight were seen in all countries but Romania. While not individually statistically significant, the mean odds ratio was 1.26 (95% CI 1.03-1.55), with no evidence of between-country heterogeneity. Obese children were few (2.7%), and associations between obesity and maternal smoking during pregnancy were more heterogeneous, with odds ratios ranging from 0.71 (0.32-1.57) in Poland to 5.49 (2.11-14.30) in Slovakia. Between-country heterogeneity was strongly related to average persons-per-room, a possible socioeconomic indicator, with stronger associations where households were less crowded. Estimates of dose-response relationships tended to be small and non-significant, even when pooled. Our results provide evidence of a link between maternal smoking in pregnancy and childhood overweight. Associations with obesity, though strong in some countries, were less consistent. Maternal smoking may confer an addition to a child's potential for obesity, which is more likely to be realised in affluent conditions.

The presence of acidic and neutral drugs in treated sewage effluents and receiving waters in the Cornwallis and Annapolis River watersheds and the Mill CoveSewage Treatment Plant in Nova Scotia, Canada

Pharmaceuticals are designed to have physiological effects on target organisms. Their presence and effect in aquatic ecosystems in the Annapolis Valley in Nova Scotia is relatively unknown. Over-the-counter (OTC) and prescription drugs are continually introduced to aquatic ecosystems through treated sewage effluent outflows into rivers and other bodies of water. Fouracidic and two neutral pharmaceuticals were monitored in the effluents from nine sewage treatment plants in the Annapolis Valley and Halifax Regional Municipality (HRM) in Nova Scotia. Naproxen and ibuprofen, two highly used OTC drugs, were the most prominent and were detected at high ng/L to low μg/L levels. Caffeine, salicylic acid (a metabolite of acetylsalicylic acid) and cotinine were detected in the ng/L range. Warfarin was not detected above the detection limits. The urban sewage treatment plant in Mill Cove, HRM showed much higher concentrations of pharmaceuticals than rural facilities in the Annapolis Valley, despite the fact that more advanced facilities are used at the urban plant. Receiving waters both downstream and upstream from STP effluent outfalls were also studied, and trace levels of caffeine at several sites indicate some degree of pollution propagation into surrounding aquatic ecosystems.

Social norms, collective efficacy, and smoking cessation in urban neighborhoods

OBJECTIVES

We examined the separate and combined relations of neighborhood-level social norms and collective efficacy with individuals' cigarette smoking cessation.

METHODS

We modeled the hazard of quitting over a 5-year period among 863 smokers who participated in the 2005 New York Social Environment Study.

RESULTS

In adjusted Cox proportional hazard models, prohibitive neighborhood smoking norms were significantly associated with higher rates of smoking cessation (second quartile hazard ratio [HR] = 1.17; 95% confidence interval [CI] = 0.59, 2.32; third quartile HR = 2.37; 95% CI = 1.17, 4.78; fourth quartile HR = 1.80; 95% CI = 0.85, 3.81). We did not find a significant association between neighborhood collective efficacy and cessation or significant evidence of a joint relation of collective efficacy and smoking norms with cessation.

CONCLUSIONS

Neighborhood social norms may be more relevant than is collective efficacy to smoking cessation. The normative environment may shape health behavior and should be considered as part of public health intervention efforts.

Self-reported tobacco smoke exposure and plasma cotinine levels during pregnancy--a validation study in Northern Japan

Maternal smoking is a critical public health concern requiring the establishment of its prevalence rate and clinical impact. Maternal self-reported information of tobacco smoke exposure requires validation using accurate biochemical analysis. This study examined the association between self-reported exposure to tobacco smoke and plasma cotinine level in Japanese pregnant women. We collected information about smoking and secondhand smoke (SHS) exposure during pregnancy from 5128 pregnant women in a prospective cohort design, and analyzed biochemically maternal blood samples using the enzyme-linked immunosorbent assay (ELISA) technique. Based on self-reports, the subjects were classified into three groups: 650 smokers, 728 ex-smokers and 3750 non-smokers. Using the receiver operating characteristic (ROC) curve, plasma cotinine cut-off value of 11.48 ng/mL was established for separating smokers from non-smokers, resulting in a smoking prevalence of 14%. A cotinine cut-off value of 0.21 ng/mL for discriminating exposed and unexposed nonsmokers resulted in a 63% prevalence of exposure to tobacco smoke among nonsmokers. Cotinine biomarker analysis proved accurate in validating self-reported smoking information in the subjects. Lower validity of SHS exposure suggests a need to confirm questionnaire information with biochemical analysis.

The impact of smoking on complications after operatively treated ankle fractures--a follow-up study of 906 patients

OBJECTIVES

This study on patients with operatively treated ankle fractures aimed to investigate the impact of smoking on postoperative complications and especially deep wound infections.

DESIGN

Cohort study with prospective follow-up.

SETTING

University-associated teaching hospital with advanced trauma care.

PATIENTS

A consecutive series of patients (n = 906) operatively treated for an acute ankle fracture during a 3-year period was identified. For the analysis, the patients were categorized as nonsmokers (n = 721) and smokers (n = 185). Data were collected from the department database and completed with a review of the patients' medical charts.

MAIN OUTCOME MEASURES

Postoperative complications.

RESULTS

Follow-up data at 6 weeks were available for 98.2% of the patients. Postoperative complications of any kind (30.1% versus 20.3%, P = 0.005) as well as deep wound infections (4.9% versus 0.8%, P < 0.001) were more common among smokers than nonsmokers. Multivariable analyses showed that smokers had six times higher odds of developing a deep infection compared with nonsmokers. A more complicated fracture, associated diabetes mellitus, and unsatisfactory operative fracture reduction also enhanced the risk of postoperative complications.

CONCLUSIONS

We conclude that cigarette smoking increases the risk of postoperative complications in patients operatively treated for an ankle fracture. Smoking is a considerable risk factor. Therefore, physicians, nurses, and other healthcare professionals should strive to support patients to stop smoking while still under acute treatment.

Smoking differences between employees in faculties of the University of Tartu, Estonia, and changes during the country's transition

Background

A previous study found marked differences in smoking between employees in various university faculties in Tartu, Estonia, soon after the disruption of communism. The present study was conducted to see whether such differences still exist and how the patterns had changed during the country's first transitional decade.

Methods

All employees at the University of Tartu (UT) were surveyed for smoking habits by means of a questionnaire in 1992 and 2003. The present paper is based on respondents whose faculty or workplace was known (1390 people in 1992, 1790 in 2003). Smoking differences were assessed in terms of regression-based adjusted figures.

Results

While 20% of the male employees smoked daily in 1992, 13% did so in 2003, the figures for females being 10% and 7%, respectively. The prevalence of men's daily smoking varied between faculties and other workplaces in the range 4-30% in 1992, and 0-24% in 2003, with corresponding ranges of 3-21% and 0-10% among females. Men in the medical faculty in both surveys, and those in the faculty of philosophy in the second survey showed higher rates than men in most other faculties, as did women in the faculty of law in the first survey and those in the faculty of philosophy in the second. The figures were usually low in the faculties of sports & exercise, physics & chemistry and mathematics. The sex pattern was reversed in the faculty of law and also in that of economics, where the women smoked more than the men.

Conclusions

Even in this low-smoking academic community, wide smoking differences existed between the faculties and other workplaces. Faculties where physical or mental performance is of prime importance are leading the way towards a smoke-free community, while men in the faculty of philosophy and, paradoxically, men in the medical faculty are lagging behind. The reversed sex ratio in the faculties of law and economics may indicate women's intensified drive for equality in this transitional society. We assume that different professional cultures may introduce variations in smoking patterns, thereby modifying the course of the smoking epidemic.

Acculturation status has a modest effect on smoking prevalence among a cohort of Pacific fathers in New Zealand

OBJECTIVE

This article explores the relationship between smoking prevalence and acculturation among a cohort of Pacific Island fathers resident in New Zealand.

METHODS

Overall, 766 Pacific fathers were included in the analysis. Self-reported smoking status was assessed and compared with data from a robust epidemiological measure of acculturation status specifically designed for use amongst the Pacific population. Additional variables describing socio-demographic and other circumstances of the participating fathers were also incorporated in the analysis because of their known association with smoking behaviour.

RESULTS

Overall, 40.3% of Pacific fathers were current smokers. Multivariable logistic regression showed that acculturation status was associated with smoking crude (p<0.001) and multivariable logistic regression models, when adjusting to socio-demographic variables (p=0.008).

CONCLUSION

Smoking rates for Pacific fathers in New Zealand are high. There appears to be a modest effect of acculturation on smoking prevalence, where those fathers with higher Pacific cultural identity have the lowest smoking rates. It is opined that the strength of identification and a holistic view of health enhances the motivations of Pacific fathers to be smoke-free in New Zealand.

IMPLICATIONS

Strategies which maintain, enhance, and incorporate fathers' Pacific cultural identity may be a useful addition to comprehensive tobacco control strategies to reduce the prevalence of smoking in Pacific people living in New Zealand.

Regional surveillance of social and geographic inequalities in smoking: the case of Montréal, Canada

Surveillance of social inequalities in health is a platform for action. We examined the trends in smoking behaviours (current and ever smoking, quit ratios) according to education and place of residence and we quantified the observed inequalities. Data were from repeated cross-sectional surveys (2003-2009) of Montreal (Canada) residents ≥15 years (n=12,053). Trends in smoking behaviours according to education were measured with logistic and log-binomial regressions. Spatial distribution of smoking behaviours across local areas was assessed with Morans' Index. Observed inequalities were quantified with prevalence ratio and difference, population attributable risk, and slope index of inequality. Results showed that ever smoking rose among low-educated individuals. Among their high-educated fellow-citizens, current smoking decreased and quit ratios increased. Adverse smoking behaviours (current and ever smoking) were clustered in south-central areas. We conclude that smoking inequalities in Montreal are growing. We thus encourage a closer monitoring of smoking social differentials.

Exposure to secondhand smoke in Finnish workplaces and compliance with national smoke-free workplace legislation

Aims: The present study examined time trends and associations in exposure to secondhand smoke (SHS) at work in Finland in 1985—2008 and compliance with national smoke-free workplace legislation that has been enforced since 1995. Methods: The study population comprised respondents of nationally representative annual postal surveys from 1985 to 2008. The differences in the prevalence of SHS-exposed respondents were measured with particular reference to workplace size and workplace smoking arrangements. Results: From 1985 to 2008 daily exposure to SHS at work decreased in all workplaces. The annual decrease was largest in 1994—95 when the smoke-free workplace legislation was enacted. The proportion of exposed employees in workplaces with designated smoking rooms was two-fold compared to employees in workplaces where no one smoked, and this ratio remained unchanged between 1995 and 2008. Employees in small workplaces were exposed most and exposure to SHS was lowest in the largest workplaces. Conclusions: Totally smoke-free workplaces give better protection against the exposure to SHS than workplaces with designated smoking areas. We urge a law reform that does not allow any designated smoking rooms indoors. In the prevention of SHS exposure, special attention should be directed to small workplaces.

An exploration of differences in sleep characteristics between Mexico-born US immigrants and other Americans to address the Hispanic Paradox

STUDY OBJECTIVES

Decreased sleep duration and quality are associated with poor health. Given that Mexico-born US immigrants (MI) often have favorable health status relative to the general US population (USALL), we tested the hypothesis that MI have better sleep as compared to USALL and to Mexican-Americans (MA) born in the US.

RESEARCH DESIGN AND METHODS

Cross-sectional analysis of a stratified multistage probability sample of 18 years and older civilian non-institutionalized USALL enrolled in NHANES during 2005-2006. Age-adjusted population prevalence rates and adjusted odd ratios of short habitual sleep time (SHST) and insomnia were calculated using weighted analyses.

SETTING

Computer assisted personal bilingual (English/Spanish) interviews in the participants' home using a sleep questionnaire.

PARTICIPANTS

5160 USALL participants, including 1046 MA, of whom 620 were MI.

RESULTS

In logistic regression models unadjusted and adjusted for socioeconomic characteristics, health related behavior risk factors, health status, and depression, MI status was significantly associated with lower odds of SHST (OR = 0.7, 95%CI [0.6-0.9]), insomnia (OR = 0.3, 95%CI [0.2-0.5]), and sleep-associated functional impairments (OR = 0.4, 95%CI [0.2-0.8]). In MA males, MI status was associated with reduced odds of SHST < 7 h/weeknight and insomnia symptoms. Cultural changes measured by increased levels of English compared to Spanish language spoken at home were associated with an increased risk of poor sleep in MA men in univariate models, and may partially explain better sleep in MI men compared to their US-born counterparts.

CONCLUSION

Compared to the general US poplulation, Mexican-born US immigrants have more favorable sleep, possibly contributing to their lower reported risk of diabetes, hypertension, CVD, and all-cause mortality (the "Hispanic Paradox").

Performance of the international physical activity questionnaire (short form) in subgroups of the Hong Kong chinese population

BACKGROUND

The International Physical Activity Questionnaire (IPAQ-SF) has been validated and recommended as an efficient method to assess physical activity, but its validity has not been investigated in different population subgroups. We examined variations in IPAQ validity in the Hong Kong Chinese population by six factors: sex, age, job status, educational level, body mass index (BMI), and visceral fat level (VFL).

METHODS

A total of 1,270 adults (aged 42.9 ± SD 14.4 years, 46.1% male) completed the Chinese version of IPAQ (IPAQ-C) and wore an accelerometer (ActiGraph) for four days afterwards. The IPAQ-C and the ActiGraph were compared in terms of estimated Metabolic Equivalent Task minutes per week (MET-min/wk), minutes spent in activity of moderate or vigorous intensity (MVPA), and agreement in the classification of physical activity.

RESULTS

The overall Spearman correlation (ρ) of between the IPAQ-C and ActiGraph was low (0.11 ± 0.03; range in subgroups 0.06-0.24) and was the highest among high VFL participants (0.24 ± 0.05). Difference between self-reported and ActiGraph-derived MET-min/wk (overall 2966 ± 140) was the smallest among participants with tertiary education (1804 ± 208). When physical activity was categorized into over or under 150 min/wk, overall agreement between self-report and accelerometer was 81.3% (± 1.1%; subgroup range: 77.2%-91.4%); agreement was the highest among those who were employed full-time in physically demanding jobs (91.4% ± 2.7%).

CONCLUSIONS

Sex, age, job status, educational level, and obesity were found to influence the criterion validity of IPAQ-C, yet none of the subgroups showed good validity (ρ = 0.06 to 0.24). IPAQ-SF validity is questionable in our Chinese population.

Associations of nicotine intake measures with CHRN genes in Finnish smokers

INTRODUCTION

Genetic effects contribute to individual differences in smoking behavior. Persistence to smoke despite known harmful health effects is mostly driven by nicotine addiction. As the physiological effects of nicotine are mediated by nicotinic acetylcholine receptors (nAChRs), we aimed at examining whether single nucleotide polymorphisms (SNPs) residing in nAChR subunit (CHRN) genes, other than CHRNA3/CHRNA5/CHRNB4 gene cluster previously showing association in our sample, are associated with smoking quantity or serum cotinine levels.

METHODS

The study sample consisted of 485 Finnish adult daily smokers (age 30-75 years, 59% men) assessed for the number of cigarettes smoked per day (CPD) and serum cotinine level. We first studied SNPs residing on selected nAChR subunit genes (CHRNA2, CHRNA4, CHRNA6/CHRNB3, CHRNA7, CHRNA9, CHRNA10, CHRNB2, CHRNG/CHRND) genotyped within a genome-wide association study for single SNP and multiple SNP associations by ordinal regression. Next, we explored individual haplotype associations using sliding window technique.

RESULTS

At one of the 8 loci studied, CHRNG/CHRND (chr2), single SNP (rs1190452), multiple SNP, and 2-SNP haplotype analyses (SNPs rs4973539-rs1190452) all showed statistically significant association with cotinine level. The median cotinine levels varied between the 2-SNP haplotypes from 220 ng/ml (AA haplotype) to 249 ng/ml (AG haplotype). We did not observe significant associations with CPD.

CONCLUSIONS

These results provide further evidence that the γ-δ nAChR subunit gene region is associated with cotinine levels but not with the number of CPD, illustrating the usefulness of biomarkers in genetic analyses.

Evaluation of the CHOICES program of peer-to-peer tobacco education and advocacy

CHOICES is a consumer driven program for addressing tobacco in people with mental illness that employs mental health peer counselors. Since 2005, CHOICES has conducted over 298 community visits reaching more than 10,000 smokers with mental illness (about 2500/year). A telephone based outcome study was conducted in 102 outpatient smokers who received a CHOICES peer-to-peer session. At 1-month follow up participants (N = 86; 84%) reported smoking an average of 13 cigarettes per day which was significantly reduced from a baseline of 19 (P < 0.001). Twenty-five individuals (29%) tried to quit smoking in the month after the peer session and another 47 (55%) reduced their smoking. Feedback from smokers about the program was positive. Most (N = 59, 71%) said it was a lot easier to talk with a consumer about smoking compared to their psychiatrist or staff. Peer-to-peer communication about tobacco use can be effective to increase awareness and change smoking behaviors.

Smokers show less improvement than nonsmokers two years after surgery for lumbar spinal stenosis: a study of 4555 patients from the Swedish spine register

STUDY DESIGN

A cohort study based on the Swedish Spine Register.

OBJECTIVE

To determine the relation between smoking status and disability after surgical treatment for lumbar spinal stenosis.

SUMMARY OF BACKGROUND DATA

Smoking and nicotine have been shown to inhibit lumbar spinal fusion and promote disc degeneration. No association, however, has previously been found between smoking and outcome after surgery for lumbar spinal stenosis. A large prospective study is therefore needed.

METHODS

All patients with a completed 2-year follow-up in the Swedish Spine Register operated for central lumbar stenosis before October 1, 2006 were included. Logistic regression was used to assess the association between smoking status and outcomes.

RESULTS

Of 4555 patients enrolled, 758 (17%) were current smokers at the time of surgery. Smokers had an inferior health-related Quality of Life at baseline. Nevertheless, adjusted for differences in baseline characteristics, the odds ratio (OR) for a smoker to end up dissatisfied at the 2-year follow-up after surgery was 1.79 [95% confidence interval (CI) 1.51-2.12]. Smokers had more regular use of analgesics (OR 1.86; 95% CI 1.55-2.23). Walking ability was less likely to be significantly improved in smokers with an OR of 0.65 (95% CI 0.51-0.82). Smokers had inferior Quality of Life also after taking differences before surgery into account, either when measured with the Oswestry Disability Index (ODI; P < 0.001), EuroQol (P < 0.001) or Short Form (36) Health Survey (SF-36) BP and SF-36 PF (P < 0.001). The differences in results between smokers and nonsmokers were evident, irrespective of whether the decompression was done with or without spinal fusion.

CONCLUSION

Smoking is an important predictor for 2-year results after surgery for lumbar spinal stenosis. Smokers had less improvement after surgery than nonsmokers.

Evaluation of self-reported measures for prediction of periodontitis in a sample of Brazilians

BACKGROUND

Questionnaires including self-reported measures have become effective as a means of accessing many diseases. The aim of the present study is to evaluate the performance of a set of self-reported periodontal measures on estimating the prevalence of periodontitis.

METHODS

The sample comprised 284 individuals, aged 18 to 60 years, from Belo Horizonte, Brazil. Full-mouth periodontal examinations were performed and periodontal parameters were recorded. Periodontitis was categorized as no or mild, moderate, and severe. Each participant answered 18 questions covering sociodemographic variables, known risk factors, and self-reported periodontal measures. Questions were globally tested through logistic regression analysis.

RESULTS

The complete final model for moderate periodontitis included age, dental flossing, and gum disease (sensitivity = 23.1%; specificity = 98%; area under the receiver operating characteristic curve = 75.4%). The complete final model for severe periodontitis included all previously cited variables in addition to the number of teeth (sensitivity = 36.4%; specificity = 96.9%; area under the receiver operating characteristic curve = 85.3%).

CONCLUSIONS

Self-reported periodontal measures showed a moderate predictive value for periodontitis prevalence. The use of these measures could be a good strategy in investigating prevalence of periodontal disease.