Validation of self-reported smoking status by simultaneous measurement of carbon monoxide and salivary thiocyanate

Self-management behaviors do not affect remission but mediate between mental health and disease outcomes in a longitudinal study of rheumatoid arthritis

Mental health has been shown to impact rheumatoid arthritis (RA) outcomes and is associated with self-management behaviors. The extent to which mental health impacts outcomes via different self-management behaviours has not been thoroughly investigated. Adult RA patients who were starting a new medication or dosage were recruited to a prospective cohort with follow-ups at 3 and 12-months covering clinical and patient-reported outcomes. The longitudinal relationships between mental health, self-management behaviors (diet, physical activity, sleep, smoking, alcohol, and medication nonadherence), disease outcome, and function were assessed. Self-management behaviors were considered mediators of mental health at baseline on outcomes at 3 and 12 months. Depression did not worsen the odds of EULAR response for the total PHQ at 3 months (OR = 0.96, p = 0.36) or 12 months (OR = 0.99, p = 0.99) nor for the categorical PHQ at 3 months (OR = 0.64, p = 0.34) or 12 months (OR = 0.67, p = 0.44). Anxiety also did not worsen the odds of EULAR response for the total GAD at 3 months (OR = 0.98, p = 0.76) or 12 months (OR1.04, 0.53) nor for the categorical GAD at 3 months (OR = 0.99, p = 0.99) or 12 months (OR = 0.94, p = 0.75). However, depression was associated with the DAS-28 at 3 months (b = 0.22, p = 0.04). Among the self-management behaviors, insomnia was found to be a significant mediator between depression and the WSAS (b = 0.08, p = 0.03) as well as anxiety and the WSAS (b = 0.07, p = 0.03). Alcohol was also a significant mediator between depression and the DAS-28 (b = 0.21, p = 0.04). Mental health was associated with worse quality of life and disease outcomes, but not EULAR response. Self-management behaviors were associated with disease outcomes and mental health.

A Comprehensive Secondary Prevention Benchmark (2PBM) Score Identifying Differences in Secondary Prevention Care in Patients After Acute Coronary Syndrome

PURPOSE

The objective of this study was to quantify secondary prevention care by creating a secondary prevention benchmark (2PBM) score for patients undergoing ambulatory cardiac rehabilitation (CR) after acute coronary syndrome (ACS).

METHODS

In this observational cohort study, 472 consecutive ACS patients who completed the ambulatory CR program between 2017 and 2019 were included. Benchmarks for secondary prevention medication and clinical and lifestyle targets were predefined and combined in the comprehensive 2PBM score with maximum 10 points. The association of patient characteristics and achievement rates of components and the 2PBM were assessed using multivariable logistic regression analysis.

RESULTS

Patients were on average 62 ± 11 yr of age and predominantly male (n = 406; 86%). The types of ACS were ST-elevation myocardial infarction (STEMI) in 241 patients (51%) and non-ST-elevation myocardial infarction in 216 patients (46%). Achievement rates for components of the 2PBM were 71% for medication, 35% for clinical benchmark, and 61% for lifestyle benchmark. Achievement of medication benchmark was associated with younger age (OR = 0.979: 95% CI, 0.959-0.996, P = .021), STEMI (OR = 2.05: 95% CI, 1.35-3.12, P = .001), and clinical benchmark (OR = 1.80: 95% CI, 1.15-2.88, P = .011). Overall ≥8 of 10 points were reached by 77% and complete 2PBM by 16%, which was independently associated with STEMI (OR = 1.79: 95% CI, 1.06-3.08, P = .032).

CONCLUSIONS

Benchmarking with 2PBM identifies gaps and achievements in secondary prevention care. ST-elevation myocardial infarction was associated with the highest 2PBM scores, suggesting best secondary prevention care in patients after ST-elevation myocardial infarction.

The impact of smoking on periodontal status and dental caries

INTRODUCTION

Investigations to explore the relationship between smoking and its oral manifestations are important to clinicians. Among these oral manifestations, periodontal diseases and dental caries have still a controversial association. This study aims to analyze the effect of smoking on periodontal disease and caries and their relevance to each other.

METHODS

Data on demographic and clinical features were retrieved from 7028 patients. Smoking status was categorized as a smoker, non-smoker, former smoker and passive smoker. Each patient received a diagnosis according to the new classification system for periodontal disease, in which periodontal disease is divides into stages (PS). The carries status was diagnosed by evaluating the decayed, missing, and filled teeth (DMFT) index.

RESULTS

Of the patients, 66.6% were non-smoker women, whereas 53.7 % of passive smokers were women. Being a worker and having a Bachelor’s degree was associated with a higher likelihood of getting diagnosed with periodontal disease and caries in smokers. Smoking significantly influences periodontal disease severity and DMFT values (p<0.001). This becomes more evident in former smokers by showing the highest severe periodontal problems (PS3: 29.7% and PS4: 18.9%), and the highest DMFT mean (16.4 ± 7.4) Accordingly, persons having high DMFT had significantly the most severe periodontal disease, namely PS4 (p<0.05).

CONCLUSIONS

Smoking is associated with higher caries prevalence and more severe periodontal disease, and DMFT tend to increase with the severity of periodontitis in the same subjects.

[Do COPD patients lie about their smoking habit?]

OBJECTIVE

To determine the deception rate or concordance between the interview on smoking and cooximetry in COPD patients from a monographic consultation.

DESIGN

Prospective observational study to evaluate the concordance between the values of cooximetry and the response to a clinical interview on smoking.

SETTING

COPD monographic consultation, Pneumology, Seville.

PARTICIPANTS

Patients with a confirmed diagnosis of COPD in any degree.

INTERVENTIONS

Clinical interview and measurement of carbon monoxide by cooximetry.

MAIN MEASUREMENTS

Cooximetry values, responses on smoking, sociodemographic variables.

RESULTS

n: 169. 107 patients presented values less than or equal to 6 ppm compared to 62 with values greater than 6 ppm, determining a prevalence of active smoking of 36.7%. The deception rate was 19.5% of the total sample (24.3% of all those who claimed not to smoke), with a Cohen kappa of 0.48 and p < 0.000. 40% of patients confessed not having told the truth. No relationship of this data was found with age, accumulated tobacco consumption or FEV1. A significant relationship with sex was found (deception rate: 31.8% in women vs. 15.2% in men, p 0.017).

CONCLUSIONS

In spite of our attempts to make patients stop smoking, a considerable deception rate was found in our consultation; higher among women, recent ex-smokers or in the process of abandonment, so it would be essential to incorporate objective measures such as the cooximeter in the approach of this type of patient.

Consistency and reliability of smoking-related variables: longitudinal study design in asthma and COPD

Introduction: Smoking has a significant impact on the development and progression of asthma and chronic obstructive pulmonary disease (COPD). Self-reported questionnaires and structured interviews are usually the only way to study patients' smoking history. In this study, we aim to examine the consistency of the responses of asthma and COPD patients to repeated standardised questions on their smoking habits over the period of 10 years. Methods: The study population consisted of 1329 asthma and 959 COPD patients, who enrolled in the study during years 2005-2007. A follow-up questionnaire was mailed to the participants 1, 2, 4, 6, 8, and 10 years after the recruitment. Results: Among the participants who returned three or more questionnaires (N = 1454), 78.5 % of the patients reported unchanged smoking status (never smoker, ex-smoker or current smoker) across the time. In 4.5% of the answers, the reported smoking statuses were considered unreliable/conflicting (first never smoker and, later, smoker or ex-smoker). The remainder of the patients changed their status from current smoker to ex-smoker and vice versa at least once, most likely due to struggling with quitting. COPD patients were more frequently heavy ex- or current smokers compared to the asthma group. The intraclass coefficient correlations between self-reported starting (0.85) and stopping (0.94) years as well as the consumption of cigarettes (0.74) over time showed good reliability among both asthma and COPD patients. Conclusion: Self-reported smoking data among elderly asthma and COPD patients over a 10-year follow-up is reliable. Pack years can be considered a rough estimate for their comprehensive consumption of tobacco products over time. We also observed that the questionnaire we used was not designed for dynamic changes in smoking which are rather common among heavy smokers especially when the follow-up time is several years, as in our study.

Examining the Relation Between Physiological and Psychological Components of Stress Reactivity and Recovery in Cigarette Smokers

Cigarette smokers exhibit reduced physiological stress reactivity, yet it is unclear whether blunted reactivity predicts differences in subjective recovery and vice versa. The study examined whether basal heart rate and heart rate reactivity were related to recovery in anxiety following stress, and conversely, whether initial self-reported anxiety and anxiety reactivity were related to heart rate recovery. Fifty-six smokers completed a 10-min baseline period, a 4-min stressor, and a 10-min recovery period during which heart rate and anxiety were continuously assessed. Results indicated significant linear (p < .01, d = 0.31) and quadratic (p = .02, d = 0.27) effects of baseline heart rate and reactivity (linear p < .01, d = 0.80; quadratic p < .01, d = 0.66) on recovery in anxiety and significant linear (p < .01, d = 0.88) and quadratic (p < .01, d = 0.74) effects of anxiety reactivity on heart rate recovery. These findings suggest that reduced reactivity in both heart rate and anxiety predicted slower recovery in the opposite domain. Findings offer initial evidence for psychophysiological integration in cigarette smokers.

Smoking in Italy 2003, with a Focus on the Young

Aims and background

To update trends in smoking prevalence in Italy to 2003, with specific focus on the young.

Methods

A population-based, face-to-face survey conducted in February-April 2003 on 3,535 individuals aged 15 or over, representative of the whole Italian adult population, plus an over sampling of 426 subjects aged 15 to 24 years.

Results

Overall, 27.6% of Italians described themselves as current cigarette smokers (33.2% men, 22.5% women); 20.1% of men and 8.0% of women smoked 15 or more cigarettes per day. Ex-smokers were 16.6% (22.5% men, 11.2% women). No appreciable difference with reference to geographic area was observed. Less educated men, but more educated women, were more frequently smokers. As compared to previous years, no noticeable change was observed in overall smoking prevalence. However, an appreciable decline was observed in the young (15 to 24 years), from 37.6% in 2001 to 32.6% in 2003 for men, and from 30.4% to 20.7% for women. Among current smokers, 40.6% had tried at least once to stop. Of these, only 6.8% had used some pharmacological and 1.8% some psychological support.

Conclusions

Overall self-reported smoking prevalence had not appreciably changed over the last few years. However, prevalence of smoking appears to have declined in the young. Compared to legal sale data, tobacco consumption is substantially under reported.

Smoking in Italy, 2002

Aims and background

To update estimates of smoking prevalence in Italy to the year 2002.

Methods

Population-based, face-to-face survey conducted by the DOXA (the Italian Branch of the Gallup International Association) in March-April 2002 on 3,238 individuals aged 15 or over, representative of the whole Italian population.

Results

Overall, 26.6% of Italian adults were current cigarette smokers (31.1% of men, 22.3% of women); 19.9% of men and 10.4% of women smoked 15 or more cigarettes per day. Ex-smokers were 15.2% (21.9% of men, 9.0% of women). There was no appreciable difference with reference to geographic area or education in men, but more educated women were more frequently smokers (28%). Compared to 2001, reported smoking prevalence declined by 3.7% in men and 1.3% in women, and the fall was evident in various age groups, including the youngest one (15–24 years). However, part of the fall is likely due to increased underreporting, since these survey figures are appreciably underestimated as compared to sale data. Among ex-smokers, 84% had stopped without support. Among smokers, 37% had tried at least once to stop. Using the Fagerström questionnaire, 69.5% of smokers were classified as low or very low dependent, whereas only 20.0% of smokers were classified as high or very high dependent. Women, younger and elderly, as well as more educated smokers of both sexes tended to be less dependent.

Conclusions

Self-reported smoking prevalence tends to decline in Italy, although the overall figure (26.6% of Italian adults) remains considerably higher than the USA and several Western European countries.

A retrospective analysis of the comparative effectiveness of smoking cessation medication among individuals with mental illness in community-based mental health and addictions treatment settings

WHAT IS KNOWN ON THE SUBJECT?: Persons with different mental illnesses smoke for reasons based on their particular diagnosis. As compared to those without, persons with mental illnesses are less able to quit smoking when using smoking cessation medications. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper shows that there may be differences in the ability to quit smoking between persons with different mental illness diagnoses. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Clinicians should be aware that persons with anxiety disorders may find it more difficult to quit smoking as compared to those with other mental illnesses. Clinicians should be aware that of all medications, varenicline seems to help those with mood disorders to quit the best. Clinicians should be aware that persons with psychotic disorders likely need longer treatment durations for smoking cessation as compared to persons with other mental illnesses.

ABSTRACT

Introduction Individuals with mental illnesses (MI) have diagnosis-specific reasons for smoking and achieve low smoking cessation when using cessation medications. Aim To assess differences in smoking cessation outcomes by MI diagnosis and cessation medications in outpatient mental health and addictions treatment settings in Vancouver, Canada. Method This is a retrospective analysis of tobacco treatment outcomes from 539 participants. The programme consists of cessation pharmacotherapy with 8 to 12 weeks of behavioural counselling and 12 weeks of support group. Smoking cessation was verified by expired carbon monoxide levels. Generalized estimating equations models assessed differences in cessation by type of medication in both total and stratified samples. Results There were no significant differences in cessation by pharmacotherapy in the total sample. Individuals with a mood disorder were two times more likely to achieve cessation as compared to those with an anxiety disorder. Among individuals with mood disorders, receiving varenicline alone resulted in three times the likelihood of cessation as compared to receiving single NRT. Discussion The differences in outcomes by MI diagnosis suggest the need for more diagnosis-specific approaches to optimize cessation. Implications for Practice Compared with other diagnoses, persons with anxiety disorders may have a greater challenge quitting and those with a psychotic disorder may require longer treatment durations.

Public Support for Electronic Cigarette Regulation in Hong Kong: A Population-Based Cross-Sectional Study

This study aimed to gauge the Hong Kong's public support towards new e-cigarette regulation, and examine the associated factors of the support. We conducted a two-stage, randomized cross-sectional telephone-based survey to assess the public support towards the banning of e-cigarette promotion and advertisement, its use in smoke-free venues, the sale to people aged under 18, and regulating the sale of nicotine-free e-cigarettes. Adults (aged 15 years or above) who were never smoking (n = 1706), ex-smoking (n = 1712) or currently smoking (n = 1834) were included. Over half (57.8%) supported all the four regulations. Banning of e-cigarette promotion and advertisement (71.7%) received slightly less support than the other three regulations (banning of e-cigarette use in smoke-free venues (81.5%); banning of e-cigarette sale to minors (93.9%); sale restriction of nicotine-free e-cigarettes (80.9%)). Current smokers, and perceiving e-cigarettes as less harmful than traditional cigarettes or not knowing the harmfulness, were associated with a lower level of support. Our findings showed a strong public support for further regulation of e-cigarettes in Hong Kong. Current stringent measures on tobacco and e-cigarettes, and media reports on the harmfulness of e-cigarettes may underpin the strong support for the regulation.

Measurement of smoking behavior: Comparison of self-reports, returned cigarette butts, and toxicant levels

A basic tenet of empirical research on cigarette smoking behavior is the systematic assessment of patterns of use. However, the large majority of extant research relies on smokers' retrospective reports of their average number of cigarettes per day (CPD), a measure that may be variable in terms of reliability and validity. Using data from 3 previously published studies of non-treatment-seeking daily smokers (combined N = 89), this analysis examined the reliability of self-reported CPD, the consistency of returned cigarette butts each day over 4 consecutive 24-hr periods, the validity of self-reported CPD compared with returned cigarette butts, and the relationship of CPD and returned cigarette butts to toxicant exposure. Results showed that self-reported CPD was reliable across telephone and in-person screening interviews (r = .87, p < .01). Although average self-reported CPD and returned cigarette butt counts did not differ significantly, t(87) = -1.5 to 0.3, all ns, butt counts revealed a wider range of variability in daily smoking behavior. In addition, self-reported cigarette use exhibited substantial digit bias (Whipple's index = 413.8), meaning that participants tended to round their estimates to values ending in 0 or 5. Cigarette butt counts, but not self-reported CPD, were significantly associated with exposure to smoke toxicants. However, this former relationship was revealed to be linear, but not curvilinear, in nature. These findings have implications for both research and treatment efforts, as researchers often rely on accurate assessment of CPD to predict a variety of smoking-related outcomes. (PsycINFO Database Record

Association of Smoking Status With Angina and Health-Related Quality of Life After Acute Myocardial Infarction

BACKGROUND

Smoking cessation after acute myocardial infarction (AMI) decreases the risk of recurrent AMI and mortality by 30% to 50%, but many patients continue to smoke. The association of smoking with angina and health-related quality of life (HRQOL) after AMI is unclear.

METHODS AND RESULTS

Patients in 2 US multicenter AMI registries (n=4003) were assessed for smoking and HRQOL at admission and 1, 6, and 12 months after AMI. Angina and HRQOL were measured with the Seattle Angina Questionnaire and Short Form-12 Physical and Mental Component Scales. At admission, 29% never had smoked, 34% were former smokers (quit before AMI), and 37% were active smokers, of whom 46% quit by 1 year (recent quitters). In hierarchical, multivariable, regression models that adjusted for sociodemographic, clinical and treatment factors, never and former smokers had similar and the best HRQOL in all domains. Recent quitters had intermediate HRQOL levels, with angina and Short Form-12 Mental Component Scale scores similar to never smokers. Persistent smokers had worse HRQOL in all domains compared with never smokers and worse Short Form-12 Mental Component Scale scores than recent quitters.

CONCLUSIONS

Smoking after AMI is associated with more angina and worse HRQOL in all domains, whereas smokers who quit after AMI have similar angina levels and mental health as never smokers. These observations may help encourage patients to stop smoking after AMI.

Smoking Status and Health-Related Quality of Life: Findings from the 2001 Behavioral Risk Factor Surveillance System Data

Purpose.

To examine the relationship between smoking status and health-related quality of life (HRQOL).

Design.

Our study used a cross-sectional analysis with self-reported data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS).

Setting.

United States.

Subjects.

Subjects were a representative sample of noninstitutionalized adults aged 18 years and older. After excluding respondents who reported being pregnant and for whom smoking status could not be determined, we included 209,031 respondents.

Measures.

Multiple logistic regressions were performed to examine the associations of smoking status with the four HRQOL items, controlling for demographic and health-related characteristics.

Results.

Current smokers had a higher likelihood of reporting poor general health status compared with nonsmokers and ex-smokers. Compared with nonsmokers, current smokers had a higher likelihood of reporting ≥ 14 days of poor physical health (odds ratio [OR] = 1.64, 95% confidence interval [CI] = 1.51–1.77), poor mental health (OR = 1.99, 95% CI = 1.84–2.16), and activity limitations (OR = 1.80, 95% CI = 1.63–2.00). Similarly, compared with ex-smokers, current smokers had a higher likelihood of reporting ≥ 14 days of poor physical health (OR = 1.30, 95% CI = 1.19–1.42), poor mental health (OR = 1.65, 95% CI = 1.50–1.81), and activity limitations (OR = 1.48, 95% CI = 1.32–1.65). Age, income, and presence of comorbidities also significantly explained variation in HRQOL.

Conclusions.

Our study reaffirms the significant association between smoking and HRQOL in a large nationally representative sample. Poor health associated with smoking persists as a major public health problem, and effective preventive and smoking cessation efforts should be undertaken.

Should the threshold for expired-air carbon monoxide concentration as a means of verifying self-reported smoking abstinence be reduced in clinical treatment programmes? Evidence from a Malaysian smokers' clinic

BACKGROUND

It has been proposed that the expired-air carbon monoxide (CO) threshold for confirming smoking abstinence in clinical practice be reduced below 10 ppm. Optimal thresholds may vary across regions. Data are needed to assess the impact of such a change on claimed success.

METHODS

A total of 253 smokers who attended the Tanglin quit smoking clinic in Malaysia were followed-up 1, 3 and 6 months after the target quit date. All participants received a standard behavioural support programme and were prescribed either varenicline or nicotine replacement therapy. Expired-air CO was measured at every visit. Respondents' smoking status was assessed using a range of different CO thresholds (3, 5 and 10 ppm) and the impact on quit rates was calculated. Predictors of success as defined using the different thresholds were assessed.

RESULTS

The 6-month abstinence rates were: 1 month - 54.9% at 10 ppm, 54.9% at 5 ppm and 48.6% at 3 ppm; 3 months - 36.0% at 10 ppm, 35.2% at 5 ppm and 30.4% at 3 ppm; 6 months - 24.1% at 10 ppm, 24.1% at 5 ppm and 20.6% at 3 ppm. Older smokers were more likely to be recorded as abstinent at 6 months regardless of the threshold used.

CONCLUSIONS

Reducing the threshold for expired-air carbon monoxide concentrations to verify claimed smoking abstinence from 10 ppm to 5 ppm makes minimal difference to documented success rates in Malaysian smoker's clinic patients. Reducing to 3 ppm decreases success rates slightly. Predictors of success at stopping appear to be unaffected by the threshold used.

Current smoking is associated with worse cognitive and adaptive functioning in serious mental illness

OBJECTIVE

Cigarette smoking is highly prevalent among people with bipolar disorder or schizophrenia. Few studies have examined whether smoking history is associated with adaptive functioning among individuals diagnosed with these serious mental illnesses.

METHOD

In a large relatively homogenous cohort of patients with either bipolar disorder (n=363) or schizophrenia (n=400), we investigated the association between cigarette smoking status, intensity, and cumulative exposure and performance on a comprehensive battery of neurocognitive, functional capacity, and informant-rated functional measures. The associations were adjusted for variation in sociodemographic indicators, psychopathologic symptoms, and substance use.

RESULTS

There was an average of 12 pack years of smoking across the sample. People with schizophrenia reported double the rate of current smoking compared to patients with bipolar disorder. Adjusting for demographic covariates, current smokers had worse composite cognitive functioning and poorer functional outcome than past or never smokers. There were no significant differences between never and past smokers, and these effects were evident in both bipolar disorder and schizophrenia.

CONCLUSION

Current smokers with either schizophrenia or bipolar disorder evidence worse cognitive and adaptive functioning functional outcome, even when demographic covariates are considered.

Psychosocial determinants of cigarette smoking among university students in Jordan

The objectives of this study were to describe the prevalence of cigarette use and water pipe smoking in Jordanian university students and to analyze differences in determinants between cigarette smokers and non-smokers. A cross-sectional questionnaire was administered to a random sample of 400 students (18-24 years, 51% males). Smokers were compared with non-smokers on several smoking-related determinants. Data were analyzed using descriptive statistics, t-test, χ 2 test and binary logistic regression analysis. The prevalence rates of cigarette use and water pipe smoking were 25.9% and 23.3%, respectively. Cigarette smokers differed significantly from non-smokers on almost all of the assessed determinants. The I-Change model explained 85% of the total variance of cigarette-smoking behavior. Cigarette smoking was determined by being male and older, having more depressive symptoms, having less Muslim identity, being more emancipated, perceiving more pros of smoking, having more modeling from peers and having lower self-efficacy. The popularity of cigarette use and water pipe smoking among Jordanian students necessitates health promotion interventions that motivate students not to engage in smoking behaviors by clearly outlining the outcomes of smoking and the healthier alternatives, how to cope with social influences and difficult situations in order to increase self-efficacy.

Prevalence and validity of self-reported smoking in Indigenous and non-Indigenous young adults in the Australian Northern Territory

BACKGROUND

In this study, we used data from Australia's Northern Territory to assess differences in self-reported smoking prevalence between the Indigenous and non-Indigenous populations. We also used urinary cotinine data to assess the validity of using self-reported smoking data in these populations.

METHODS

The Aboriginal Birth Cohort (ABC) is a prospective study of 686 Aboriginal babies born in Darwin 1987-90. The Top End Cohort (TEC) is a study of non-Indigenous adolescents, all born in Darwin 1987-91. In both studies, participants aged between 16 and 21 years, were asked whether they smoked. Urinary cotinine measurements were made from samples taken at the same visits.

RESULTS

Self-reported smoking prevalence was 68% in the ABC and 14% in the TEC. Among the self-reported non-smokers, the median cotinine levels were higher in the ABC (33 ng/ml) than in the TEC (5 ng/ml), with greater percentages of reported non-smokers in the under 50 ng/ml group in the TEC than in the ABC CONCLUSIONS: Prevalence of smoking was much higher in the ABC than in the TEC. The higher cotinine levels in ABC non-smokers may reflect an underestimated prevalence, but is also likely to reflect higher levels of passive smoking. A broader approach encompassing social, cultural and language factors with increased attention to smoking socialisation factors is required.

Exhaled carbon monoxide and its associations with smoking, indoor household air pollution and chronic respiratory diseases among 512,000 Chinese adults

BACKGROUND

Exhaled carbon monoxide (COex) level is positively associated with tobacco smoking and exposure to smoke from biomass/coal burning. Relatively little is known about its determinants in China despite the population having a high prevalence of smoking and use of biomass/coal.

METHODS

The China Kadoorie Biobank includes 512,000 participants aged 30-79 years recruited from 10 diverse regions. We used linear regression and logistic regression methods to assess the associations of COex level with smoking, exposures to indoor household air pollution and prevalent chronic respiratory conditions among never smokers, both overall and by seasons, regions and smoking status.

RESULTS

The overall COex level (ppm) was much higher in current smokers than in never smokers (men: 11.5 vs 3.7; women: 9.3 vs 3.2). Among current smokers, it was higher among those who smoked more and inhaled more deeply. Among never smokers, mean COex was positively associated with levels of exposures to passive smoking and to biomass/coal burning, especially in rural areas and during winter. The odds ratios (OR) and 95% confidence interval (CI) of air flow obstruction (FEV1/FVC ratio<0.7) for never smokers with COex at 7-14 and ≥14 ppm, compared with those having COex<7, were 1.38 (1.31-1.45) and 1.65 (1.52-1.80), respectively (Ptrend<0.001). Prevalence of other self-reported chronic respiratory conditions was also higher among people with elevated COex (P<0.05).

CONCLUSION

In adult Chinese, COex can be used as a biomarker for assessing current smoking and overall exposure to indoor household air pollution in combination with questionnaires.

The interaction of nicotine withdrawal and panic disorder in the prediction of panic-relevant responding to a biological challenge

The current investigation evaluated nicotine withdrawal symptoms elicited by 12 hours of smoking deprivation on anxious and fearful responding to bodily sensations among daily smokers with and without panic disorder (PD). It was hypothesized that smokers with PD who were experiencing greater levels of nicotine withdrawal would experience the greatest levels of fearful responding to, and delayed recovery from, a 10% carbon dioxide-enriched air (CO₂) biological challenge procedure. Participants were 58 adults who reported smoking 19.72 cigarettes daily (SD = 7.99). Results indicated that nicotine withdrawal and PD status interacted to predict greater postchallenge panic attack symptoms. Also, individuals with PD initially evidenced a quicker decrease in subjective anxiety following the challenge, but their rate of recovery decelerated over time as compared to those without PD. There was, however, no significant interaction for change in subjective anxiety pre- to postchallenge. Results are discussed in relation to the role of nicotine withdrawal in anxious and fearful responding for smokers with PD.

Factors affecting exposure to nicotine and carbon monoxide in adult cigarette smokers

Exposure to cigarette smoke among smokers is highly variable. This variability has been attributed to differences in smoking behavior as measured by smoking topography, as well as other behavioral and subjective aspects of smoking. The objective of this study was to determine the factors affecting smoke exposure as estimated by biomarkers of exposure to nicotine and carbon monoxide (CO). In a multi-center cross-sectional study of 3585 adult smokers and 1077 adult nonsmokers, exposure to nicotine and CO was estimated by 24h urinary excretion of nicotine and five of its metabolites and by blood carboxyhemoglobin, respectively. Number of cigarettes smoked per day (CPD) was determined from cigarette butts returned. Puffing parameters were determined through a CreSS® micro device and a 182-item adult smoker questionnaire (ASQ) was administered. The relationship between exposure and demographic factors, smoking machine measured tar yield and CPD was examined in a statistical model (Model A). Topography parameters were added to this model (Model B) which was further expanded (Model C) by adding selected questions from the ASQ identified by a data reduction process. In all the models, CPD was the most important and highest ranking factor determining daily exposure. Other statistically significant factors were number of years smoked, questions related to morning smoking, topography and tar yield categories. In conclusion, the models investigated in this analysis, explain about 30-40% of variability in exposure to nicotine and CO.

Determinants of heavy cigarette smoking: are there differences in men and women? Results from the population-based MONICA/KORA Augsburg surveys

INTRODUCTION

Heavy cigarette smoking is more frequent in men than in women. So far, little is known whether this sex-specific difference in cigarette consumption is modified by age at smoking onset, sociodemographical, and lifestyle factors. Therefore, we aimed to identify sex-specific characteristics associated with heavy daily cigarette smoking.

METHODS

The study population consisted of 3,178 daily smokers aged 25-74 years from the population-based MONICA/KORA Augsburg surveys conducted between 1984 and 1995. Subjects consuming at least 20 cigarettes daily were defined as heavy smokers. Multivariate logistic regression was used to identify sociodemographical, smoking-related, and lifestyle characteristics of heavy smokers.

RESULTS

A number of 1,576 subjects (49.6%) were identified as heavy smokers. Men were significantly more often heavy smokers than women with the exception of those women who have started smoking at an early age. Multivariate logistic regression revealed early age at smoking onset determines heavy smoking in women but not in men. While younger age at study examination and low educational level was associated with heavy smoking in men only, current employment was associated with heavy smoking in women only. Moreover, living alone, high alcohol or coffee consumption, and low physical leisure activity were associated with heavy smoking behavior in both sexes. Survey, obesity and parental history of smoking showed no association with heavy smoking.

CONCLUSIONS

The present study revealed sex-specific differences in heavy smoking by age at smoking onset, which was not shown before so far. These findings should be further investigated and addressed in future prevention campaigns.

Quantification of ETS exposure in hospitality workers who have never smoked

BACKGROUND

Environmental Tobacco Smoke (ETS) was classified as human carcinogen (K1) by the German Research Council in 1998. According to epidemiological studies, the relative risk especially for lung cancer might be twice as high in persons who have never smoked but who are in the highest exposure category, for example hospitality workers. In order to implement these results in the German regulations on occupational illnesses, a valid method is needed to retrospectively assess the cumulative ETS exposure in the hospitality environment.

METHODS

A literature-based review was carried out to locate a method that can be used for the German hospitality sector. Studies assessing ETS exposure using biological markers (for example urinary cotinine, DNA adducts) or questionnaires were excluded. Biological markers are not considered relevant as they assess exposure only over the last hours, weeks or months. Self-reported exposure based on questionnaires also does not seem adequate for medico-legal purposes. Therefore, retrospective exposure assessment should be based on mathematical models to approximate past exposure.

RESULTS

For this purpose a validated model developed by Repace and Lowrey was considered appropriate. It offers the possibility of retrospectively assessing exposure with existing parameters (such as environmental dimensions, average number of smokers, ventilation characteristics and duration of exposure). The relative risk of lung cancer can then be estimated based on the individual cumulative exposure of the worker.

CONCLUSION

In conclusion, having adapted it to the German hospitality sector, an existing mathematical model appears to be capable of approximating the cumulative exposure. However, the level of uncertainty of these approximations has to be taken into account, especially for diseases with a long latency period such as lung cancer.

Using breath carbon monoxide to validate self-reported tobacco smoking in remote Australian Indigenous communities

Background

This paper examines the specificity and sensitivity of a breath carbon monoxide (BCO) test and optimum BCO cutoff level for validating self-reported tobacco smoking in Indigenous Australians in Arnhem Land, Northern Territory (NT).

Methods

In a sample of 400 people (≥16 years) interviewed about tobacco use in three communities, both self-reported smoking and BCO data were recorded for 309 study participants. Of these, 249 reported smoking tobacco within the preceding 24 hours, and 60 reported they had never smoked or had not smoked tobacco for ≥6 months. The sample was opportunistically recruited using quotas to reflect age and gender balances in the communities where the combined Indigenous populations comprised 1,104 males and 1,215 females (≥16 years). Local Indigenous research workers assisted researchers in interviewing participants and facilitating BCO tests using a portable hand-held analyzer.

Results

A BCO cutoff of ≥7 parts per million (ppm) provided good agreement between self-report and BCO (96.0% sensitivity, 93.3% specificity). An alternative cutoff of ≥5 ppm increased sensitivity from 96.0% to 99.6% with no change in specificity (93.3%). With data for two self-reported nonsmokers who also reported that they smoked cannabis removed from the analysis, specificity increased to 96.6%.

Conclusion

In these disadvantaged Indigenous populations, where data describing smoking are few, testing for BCO provides a practical, noninvasive, and immediate method to validate self-reported smoking. In further studies of tobacco smoking in these populations, cannabis use should be considered where self-reported nonsmokers show high BCO.

Inorganic chemistry of defensive peroxidases in the human oral cavity

The innate host response system is comprised of various mechanisms for orchestrating host response to microbial infection of the oral cavity. The heterogeneity of the oral cavity and the associated microenvironments that are produced give rise to different chemistries that affect the innate defense system. One focus of this review is on how these spatial differences influence the two major defensive peroxidases of the oral cavity, salivary peroxidase (SPO) and myeloperoxidase (MPO). With hydrogen peroxide (H(2)O(2)) as an oxidant, the defensive peroxidases use inorganic ions to produce antimicrobials that are generally more effective than H(2)O(2) itself. The concentrations of the inorganic substrates are different in saliva vs. gingival crevicular fluid (GCF). Thus, in the supragingival regime, SPO and MPO work in unison for the exclusive production of hypothiocyanite (OSCN(-), a reactive inorganic species), which constantly bathes nascent plaques. In contrast, MPO is introduced to the GCF during inflammatory response, and in that environment it is capable of producing hypochlorite (OCl(-)), a chemically more powerful oxidant that is implicated in host tissue damage. A second focus of this review is on inter-person variation that may contribute to different peroxidase function. Many of these differences are attributed to dietary or smoking practices that alter the concentrations of relevant inorganic species in the oral cavity (e.g.: fluoride, F(-); cyanide, CN(-); cyanate, OCN(-); thiocyanate, SCN(-); and nitrate, NO(3)(-)). Because of the complexity of the host and microflora biology and the associated chemistry, it is difficult to establish the significance of the human peroxidase systems during the pathogenesis of oral diseases. The problem is particularly complex with respect to the gingival sulcus and periodontal pockets (where the very different defensive stratagems of GCF and saliva co-mingle). Despite this complexity, intriguing in vitro and in vivo studies are reviewed here that reveal the interplay between peroxidase function and associated inorganic chemistry.

Thiocyanate concentration in saliva of cystic fibrosis patients

Thiocyanates (SCN-) are ubiquitous in nature. There are indispensable part of host defense system that act as a substrate for lactoperoxidase (LPO). In our study we present initial data on SCN- concentration in saliva of CF patients in comparison to healthy non-smokers and healthy smokers. 5 ml of saliva was collected from each subject to a sterile tube and thiocyanate concentration was measured in each sample. The results of the measurements are presented on Fig. 1. Mean concentration of SCN- in saliva of CF patients was 0.031 +/- 0.0052 g/l, in healthy non-smokers 0.039 +/- 0.0048 g/l and in healthy smokers 0.048 +/- 0.0161 g/l. The differences between each group were statistically significant. Studies on larger group of patients and probably on different material (BALF or induced sputum) should present interesting data complementing the in vitro studies.

Measuring tobacco smoke exposure among smoking and nonsmoking bar and restaurant workers

PURPOSE

This study assesses the validity of hair nicotine as a biomarker for secondhand smoke (SHS) exposure. Although most biomarkers of tobacco-smoke exposure have a relatively short half-life, hair nicotine can measure several months of cumulative SHS exposure.

DESIGN

A cross-sectional study of hospitality-industry workers.

METHOD

Hair samples were obtained from 207 bar and restaurant workers and analyzed by the reversed-phase high-performance liquid chromatography with electrochemical detection (HPLC-ECD) method. Self-reported tobacco use and sources of SHS exposure were assessed.

FINDINGS

Higher hair-nicotine levels were associated with more cigarettes smoked per day among smokers and a greater number of SHS-exposure sources among nonsmokers. Number of SHS exposure sources, gender, number of cigarettes smoked per day, and type of establishment predicted hair-nicotine levels.

DISCUSSION

Hair nicotine is a valid measure of SHS exposure. It may be used as an alternative biomarker to measure longer term SHS exposure.

Effects of passive smoking on heart rate variability, heart rate and blood pressure: an observational study

BACKGROUND

Exposure to environmental tobacco smoke (ETS) has been shown to increase the risk for cardiovascular diseases and death, and autonomic dysfunction (specifically, reduced heart rate variability (HRV)) is a predictor of increased cardiac risk. This study tests the hypothesis that ETS exposure reduces HRV in the general population and discusses possible pathways.

METHODS

This cross-sectional study was conducted between 2001 and 2003 and is part of the SAPALDIA (Swiss Cohort Study on Air Pollution and Lung Diseases in Adults) study. The analysis included 1218 randomly selected non-smokers aged 50 and above who participated in 24-h electrocardiogram recordings. Other examinations included an interview, investigating health status (especially respiratory and cardiovascular health and health relevant behaviours and exposure to ETS) and measurements of blood pressure, body height and weight.

RESULTS

Subjects exposed to ETS at home or at work for more than 2 h/day had a difference of -15% in total power (95%CI: -26 to -3%), low frequency power (-28 to -1%), low/high frequency ratio (-26 to -3%) and -18% (-29 to -4%) in ultralow frequency power of HRV compared with subjects not exposed to ETS at home or work. We also found a 2.7% (-0.01 to 5.34%) higher heart rate during the recording in exposed subjects.

CONCLUSIONS

Exposure to ETS at home and work is associated with lower HRV and with higher heart rate in an ageing population. Our findings suggest that exposure to ETS increases cardiac risk through disturbances in the autonomic nervous system.

Expired carbon monoxide levels in self‐reported smokers and nonsmokers in prison

Breath carbon monoxide (CO) is a convenient, widely used method for abstinence validation, with cutoffs of 8-10 ppm commonly employed. The goal of the present study was to determine an appropriate CO cutoff to differentiate nonsmokers and smokers within a large sample (N = 374) of female prisoners incarcerated at a correctional facility in Virginia. Mean age of the population was 34.5 years, 49.2% were White, and 29% had less than a high school education. Smoking prevalence was 74.1% within the prison population. Examination of CO levels versus smoking self-report using a receiver operator characteristic (ROC) analysis revealed that a CO cutoff of 3 ppm resulted in the best sensitivity (98.1%) and specificity (95.8%). Overall ROC area under the curve was 99% (95% CI = 98.2%-99.9%). This same cutoff was optimal for smoking subgroups including Black and light (<10 cigarettes/day) smokers. Results suggest that CO cutoffs higher than 3 ppm may misclassify some smokers as nonsmokers and underestimate the prevalence of smoking.

Cigarette smoking and colorectal cancer risk in Germany: a population-based case-control study

Studies have shown fairly consistent positive relationships between smoking and risk of colorectal adenomas, but have yielded inconsistent results for colorectal cancer. Issues relating to the duration, cumulative dose of smoking and the effect of smoking cessation on colorectal cancer risk still need clarification. In a population-based case-control study in Germany, we recruited 540 incident cases of colorectal cancer and 614 controls matched to cases by sex, 5-year age groups and county of residence from January 2003 to June 2004. Subjects were aged>or=30 years, and provided information on risk factors of colorectal cancer, including lifetime cigarette smoking habits, in personal interviews. Odds ratios (OR) and 95% confidence intervals (CI) were computed using conditional logistic regression models, adjusting for potential confounders. Compared with nonsmokers, there was an increased risk for smoking for >or=30 years (OR: 1.25, 95% CI: 0.90-1.75) and a significant risk increase for >or=40 pack-years of smoking (OR: 1.92, 95% CI: 1.13-3.28). Stratification by sex yielded higher risk estimates among females than that among males, with adjusted ORs of 3.5 (95% CI: 1.29-9.52) and 1.15 (0.69-1.91) for women and men, respectively, following >or=30 pack-years of smoking (pinteraction=0.18). Among smokers, risk reduction was observed after >or=20 years of quitting smoking and was significant for >or=40 years (OR: 0.46; 95% CI: 0.21-0.98), when compared to current smokers (p for linear trend=0.05). This study supports the hypothesis that smoking for a long duration at a high cumulative dose increases the risk for colorectal cancer, particularly among women, and suggests that there is risk reduction after longterm smoking cessation.

Gender differentials in the evolution of cigarette smoking habits in a general European adult population from 1993-2003

Background

Describe the recent evolution of cigarette smoking habits by gender in Geneva, where incidence rates of lung cancer have been declining in men but increasing in women.

Methods

Continuous cross-sectional surveillance of the general adult (35–74 yrs) population of Geneva, Switzerland for 11 years (1993–2003) using a locally-validated smoking questionnaire, yielding a representative random sample of 12,271 individuals (6,164 men, 6,107 women).

Results

In both genders, prevalence of current cigarette smoking was stable over the 11-year period, at about one third of men and one quarter of women, even though smoking began at an earlier age in more recent years. Older men were more likely to be former smokers than older women. Younger men, but not women, tended to quit smoking at an earlier age.

Conclusion

This continuous (1993–2003) risk factor surveillance system, unique in Europe, shows stable prevalence of smoking in both genders. However, sharp contrasts in age-specific prevalence of never and former smoking and of ages at smoking initiation indicate that smoking continues a long-term decline in men but has still not reached its peak in women.

Coronary collateral circulation: the effects of smoking and alcohol

OBJECTIVE

The presence or absence of coronary collaterals is of vital importance during acute ischemia. Smoking and alcohol have been suggested to play a role, but data are scarce. We examined the extent to which smoking and alcohol use affect the presence of coronary collateral circulation.

METHODS

Cross-sectional study in 242 patients, admitted for elective PTCA. Smoking was defined as past or current. Pack years were calculated and categorized into never-smokers (reference-category): <10, 10-19, 20-29, and >or=30 pack years. Alcohol consumption was defined as past or current, and categorized into never-users (reference-category): <1, 1-10, 11-20, and >or=21 units per week (UPW). Collaterals were graded with Rentrop's classification. Coronary collateral presence was defined as Rentrop-grade >or=1.

RESULTS

Current smoking (odds ratio (OR) 4.17; 95% confidence interval (CI) 1.79-9.71) was positively associated, while pack years of smoking was not related. Current alcohol intake showed a J-shaped tendency with coronary collateral presence, while past moderate alcohol consumption was inversely associated (OR 0.19; 95% CI 0.04-0.98).

CONCLUSIONS

Smoking and (to some extent) alcohol use are associated with collateral presence. The results support the view that life-style factors may affect the formation of coronary collaterals in patients with ischemic cardiac disease.

Association between recurrent aphthous stomatitis and salivary thiocyanate levels

The aim of this work was to investigate the association between recurrent aphthous stomatitis (RAS) and salivary thiocyanate levels. The sample comprised men and women of age ranging from 15 to 55 years, who were allocated to four groups: 28 patients in RAS active phase (group 1); 28 patients in RAS remission phase (group 2); 29 smokers (group 3); 26 non-smokers without RAS (group 4). Samples of whole saliva mechanically stimulated were collected, and thiocyanate levels were measured. The results were analyzed by ANOVA and paired t-test. Mean salivary thiocyanate values were 0.55 mM, 0.64 mM, 2.36 mM and 0.96 mM in groups 1 (active RAS), 2 (remission RAS), 3 (smokers) and 4 (control), respectively. There was no significant difference in thiocyanate levels when groups 1 and 2 were compared with group 4. Group 3 showed a significantly higher thiocyanate concentration when compared with groups 1, 2 and 4 (P < 0.05). There was no significant difference in thiocyanate levels between groups 1 and 2 (P > 0.05). It is therefore suggested that there is no association between RAS and salivary thiocyanate levels.

Socio-economic status and lung cancer risk including histologic subtyping—A longitudinal study

We investigated prospectively the risk of lung cancer in relation to socio-economic status (SES) in 22,387 middle-aged individuals who attended a screening program in the city of Malmö, Sweden between 1974 and 1992. We also examined the relationship between SES and histologic subtype in smokers. By 2003, a total of 550 lung cancer cases had been identified. Relative risks (RR) were calculated with adjustment for age, current smoking, inhalation habits and marital status at baseline in the low SES group compared to high SES group. Among smokers, the RR (95% confidence interval (CI)) for lung cancer in the low SES group of men was 1.39 (1.11-1.73), and women 1.56 (1.04-2.34). Also among smokers, low SES was associated with an increased risk of squamous cell carcinoma in men; RR 1.89 (1.16-2.81) and women; RR 7.10 (1.63-30.86), and with an increased risk of mesothelioma in men RR 9.97 (1.29-76.96). We conclude that low SES groups run an increased risk of lung cancer despite accounting for smoking habits. Furthermore, low SES was positively associated with squamous cell carcinoma and mesothelioma. Our results suggest that the association between low SES and lung cancer could be mediated by unaccounted for smoking exposure, lifestyle or occupational hazards.

Smoking behaviour, cessation attempts and the influence of parental smoking in older adult women: a cross-sectional analysis from Italy

OBJECTIVES

To investigate the association between parental smoking during infancy/adolescence and smoking prevalence in older adult women, and to provide a description of smoking and smoking cessation patterns in this subset of the population.

STUDY DESIGN

Cross-sectional survey.

METHODS

Between 1999 and 2001, trained physicians in 11 health agencies throughout the Abruzzo Region, Italy, conducted semi-structured interviews on 9708 women aged 50-70 years attending mammographic screening (overall response rate 89%). Information was collected on sociodemographic characteristics, smoking habits, parental smoking during their infancy and/or adolescence, and exposure to environmental tobacco smoke (ETS) inside or outside the family.

RESULTS AND CONCLUSIONS

The overall prevalence of current smoking was 15.6% (n=1516), and that of former smoking was 13.2%. Women whose parent(s) smoked were more likely to be current smokers, especially if only the mother smoked (adjusted odds ratio 4.27; 95% confidence interval 2.24-8.12). Other factors significantly associated with current smoking in the multivariate analysis were younger age, lower body mass index, higher level of education, unmarried status, and exposure to ETS either inside or outside the family environment. Eighteen percent of all current smokers were non-inhalers, and more than 60% of ex-smokers quit smoking on their first attempt. Our findings expand the existing evidence suggesting that a strong effect of parental conduct on a daughter's smoking behaviour may persist throughout life. Although more research is needed, especially to clarify the role of genetic and environmental factors in determining the mother-child smoking association, our results suggest that intensifying smoking prevention efforts directed at women with children might considerably reduce the risk of ever smoking in future female generations.

[Veracity of smokers' reports of abstinence at smoking cessation clinics]

OBJECTIVE

To assess the reliability of smokers' response as criteria for measuring abstinence and the necessity or not of confirming abstinence with carbon monoxide (CO) measurement.

PATIENTS AND METHODS

A multicenter, prospective, longitudinal study was carried out on patients over 18 years of age from 5 smoking cessation clinics who underwent treatment with nicotine or bupropion. When the patient attended the clinic at 15, 30, 60, 90, and 180 days, abstinence was checked by self-reporting and expired-air CO levels. Sensitivity, specificity, and positive, negative, and overall predictive value of patient reporting, measured CO levels, and the 2 procedures in combination were calculated.

RESULTS

A total of 904 smokers (476 men and 428 women) with a mean (SD) age of 42.51 (10.09) years were enrolled in the study. Of the 904 patients that made up the study population, 820, 776, 687, 719, and 679, respectively, attended the scheduled visits to check abstinence. Self-reported point-prevalence abstinence at 15 days was 74.5% and at 180 days was 57.6% while abstinence determined by expired-air CO was 75.7% and 59.4% respectively. Results according to self-reporting, CO measurement, and the 2 methods in combination were not significantly different (P<.05) at any of the points in time. Neither sensitivity nor specificity showed significant differences in relation to patient variables.

CONCLUSION

The reliability of self-reported abstinence from smoking is high. Measurement of CO is therefore not essential, although it could be advisable for motivating patients rather than as a way of confirming abstinence.

Extent of exposure to environmental tobacco smoke (ETS) and its dose-response relation to respiratory health among adults

Background

There is a dearth of standardized studies examining exposure to environmental tobacco smoke (ETS) and its relationship to respiratory health among adults in developing countries.

Methods

In 2004, the Syrian Center for Tobacco Studies (SCTS) conducted a population-based survey using stratified cluster sampling to look at issues related to environmental health of adults aged 18–65 years in Aleppo (2,500,000 inhabitants). Exposure to ETS was assessed from multiple self-reported indices combined into a composite score (maximum 22), while outcomes included both self-report (symptoms/diagnosis of asthma, bronchitis, and hay fever), and objective indices (spirometric assessment of FEV₁ and FVC). Logistic and linear regression analyses were conducted to study the relation between ETS score and studied outcomes, whereby categorical (tertiles) and continuous scores were used respectively, to evaluate the association between ETS exposure and respiratory health, and explore the dose-response relationship of the association.

Results

Of 2038 participants, 1118 were current non-smokers with breath CO levels ≤ 10 ppm (27.1% men, mean age 34.7 years) and were included in the current analysis. The vast majority of study participants were exposed to ETS, whereby only 3.6% had ETS score levels ≤ 2. In general, there was a significant dose-response pattern in the relationship of ETS score with symptoms of asthma, hay fever, and bronchitis, but not with diagnoses of these outcomes. The magnitude of the effect was in the range of twofold increases in the frequency of symptoms reported in the high exposure group compared to the low exposure group. Severity of specific respiratory problems, as indicated by frequency of symptoms and health care utilization for respiratory problems, was not associated with ETS exposure. Exposure to ETS was associated with impaired lung function, indicative of airflow limitation, among women only.

Conclusions

This study provides evidence for the alarming extent of exposure to ETS among adult non-smokers in Syria, and its dose-response relationship with respiratory symptoms of infectious and non-infectious nature. It calls for concerted efforts to increase awareness of this public health problem and to enforce regulations aimed at protecting non-smokers.

SULT1A1 genotype, active and passive smoking, and breast cancer risk by age 50 years in a German case-control study

INTRODUCTION

Sulfotransferase 1A1 (encoded by SULT1A1) is involved in the metabolism of procarcinogens such as heterocyclic amines and polycyclic aromatic hydrocarbons, both of which are present in tobacco smoke. We recently reported a differential effect of N-acetyltransferase (NAT) 2 genotype on the association between active and passive smoking and breast cancer. Additional investigation of a common SULT1A1 genetic polymorphism associated with reduced enzyme activity and stability might therefore provide deeper insight into the modification of breast cancer susceptibility.

METHODS

We conducted a population-based case-control study in Germany. A total of 419 patients who had developed breast cancer by age 50 years and 884 age-matched control individuals, for whom risk factor information and detailed smoking history were available, were included in the analysis. Genotyping was performed using a fluorescence-based melting curve analysis method. Multivariate logistic regression analysis was used to estimate breast cancer risk associated with the SULT1A1 Arg213His polymorphism alone and in combination with NAT2 genotype in relation to smoking.

RESULTS

The overall risk for breast cancer in women who were carriers of at least one SULT1A1*2 allele was not significantly different from that for women with the SULT1A1*1/*1 genotype (adjusted odds ratio 0.83, 95% confidence interval 0.66-1.06). Risk for breast cancer with respect to several smoking variables did not differ substantially between carriers of the *2 allele and noncarriers. However, among NAT2 fast acetylators, the odds ratio associated with passive smoking only (3.23, 95% confidence interval 1.05-9.92) was elevated in homozygous carriers of the SULT1A1*1 allele but not in carriers of the SULT1A1*2 allele (odds ratio 1.28, 95% confidence interval 0.50-3.31).

CONCLUSION

We found no evidence that the SULT1A1 genotype in itself modifies breast cancer risk associated with smoking in women up to age 50 years. In combination with NAT2 fast acetylator status, however, the SULT1A1*1/*1 genotype might increase breast cancer risk in women exposed to tobacco smoke.

Levels and correlates of knowledge about cancer risk factors among 13,293 public school students in Morelos, Mexico

BACKGROUND

Data on young people's knowledge about cancer prevention are not currently available for many populations, including Mexican young people, although cancer is the second most common cause of death among the Mexican population.

METHODS

A questionnaire was applied to 13,293 public school students aged 11-24 years in Morelos, Mexico. A knowledge-based scale was constructed from survey answers about risk factors for cancer. Data were analyzed using multivariate logistic multinomial models.

RESULTS

Knowledge levels were low: 78% of male and 74% of female students had only wrong answers to questions about risk factors for cancer. A significant dose-response gradient was observed between age and knowledge of cancer risk factors (P < 0.001), with a higher prevalence in young women at all ages (female students OR 4.6, 95% CI 3.81-5.66). Students 18 years old and older knew more than 13-year-olds (OR = 2.39; 95% CI 1.89-3.01). Sexually active students (OR 2.10; 95% CI 1.70-2.58), especially those who consistently used condoms (OR 2.84; 95% CI 1.00-8.07), knew more about cancer prevention. Tobacco smoking was the most frequently recognized cancer risk factor, and smokers also recognized this as an important cause of cancer (OR 1.37; 95% CI 1.44-2.52).

CONCLUSIONS

Our results reveal a poor level of knowledge about cancer prevention among adolescents. These data are the first step in the development of an intervention based on empirical findings that will be susceptible to evaluation.

Oral fluid as a diagnostic tool

Technological advances over the past decades have enabled oral fluid to expand its usefulness in the diagnosis of disease, prediction of disease progression, monitoring of therapeutic drug levels and detection of illicit drugs. The easy non-invasive nature of collection and the relationship between oral fluid and plasma levels make oral fluid a valuable clinical tool. This review describes advances over the past 5 years in the area of oral fluid as a diagnostic tool, its use in therapeutic and illicit drug monitoring, including proposed guidelines for cut-off values, and methods of collection.

Lifestyle risk factors and chronic kidney disease

PURPOSE

To examine the effects of lifestyle risk factors such as alcohol consumption, cigarette smoking and body mass index (BMI) on the development of chronic kidney disease.

METHODS

We used a case-control study of 554 hospital cases and 516 age, race, and gender-matched community controls. The main outcome measure was newly-diagnosed chronic kidney disease, assessed by chart review. Self-reported history of alcohol consumption, smoking, and BMI as well as other co-variables were obtained during telephone interviews. Logistic regression models assessed the association between lifestyle risk factors and chronic kidney disease and were adjusted for important co-variables.

RESULTS

We found no significant associations between alcohol consumption and chronic kidney disease, with the exception of moonshine, which resulted in an increased risk of chronic kidney disease (including all subtypes). The effects of smoking on chronic kidney disease were inconsistent, but pointed to no appreciable excess risk among smokers. Increasing quartiles of BMI were positively and significantly associated with nephrosclerosis (ORs [95% CI]: 2.5 [1.0-6.0], 2.8 [1.2-6.8] and 4.6 [1.8-11.6], for the second, third, and fourth quartiles of BMI, respectively).

CONCLUSIONS

Our study revealed a significant positive association between BMI and nephrosclerosis. We did not find an increased risk of chronic kidney disease associated with alcohol or cigarette smoking.

KLOTHO allele status and the risk of early-onset occult coronary artery disease

We previously identified a functional variant of KLOTHO (termed "KL-VS"), which harbors two amino acid substitutions in complete linkage disequilibrium and is associated with reduced human longevity when in homozygosity. Klotho-deficient mice display extensive arteriosclerosis when fed a normal diet, suggesting a potent genetic predisposition. To determine whether klotho influences atherosclerotic risk in humans, we performed cross-sectional studies to assess the association between the KL-VS allele and occult coronary artery disease (CAD) in two independent samples of apparently healthy siblings of individuals with early-onset (age <60 years) CAD (SIBS-I [N=520] and SIBS-II [N=436]). Occult CAD was defined as the occurrence of a reversible perfusion defect during exercise thallium scintigraphy and/or as an abnormal result of an exercise electrocardiogram (SIBS-I, n=97; SIBS-II, n=56). In SIBS-I, the KL-VS allele conferred a relative odds of 1.90 (95% confidence interval 1.21-2.98) for occult CAD, after adjusting for familial intraclass correlations (P<.005). Logistic regression modeling, incorporating known CAD risk factors, demonstrated that the KL-VS allele is an independent risk factor (P<.019) and that the imposed risk of KL-VS allele status is influenced by modifiable risk factors. Hypertension (P<.022) and increasing high-density lipoprotein cholesterol (HDL-C) levels (P<.022) mask or reduce the risk conferred by the KL-VS allele, respectively, whereas current smoking (P<.004) increases the risk. Remarkably concordant effects of the KL-VS allele and modifying factors on the risk of occult CAD were seen in SIBS-II. These results demonstrate that the KL-VS allele is an independent risk factor for occult CAD in two independent high-risk samples. Modifiable risk factors, including hypertension, smoking status, and HDL-C level, appear to influence the risk imposed by this allele.

Are there gender differences in self-reported smoking practices? Correlation with thiocyanate and cotinine levels in smokers and nonsmokers from the Pawtucket Heart Health Program

OBJECTIVES

This study compared serum cotinine and thiocyanate in assessment of self-reported smoking behavior among 1400 men and 1809 women from two New England communities.

METHODS

Serum thiocyanate and serum cotinine levels were analyzed on 2411 and 798 survey respondents, respectively, in an attempt to provide an objective measurement for validation of self-reported smoking behaviors that were obtained through an in-home interviewer-administered questionnaire. Cross-sectional household surveys were conducted with randomly selected men and women, aged 18-65, between 1981 and 1993 as part of the evaluation of the Pawtucket Heart Health Program.

RESULTS

Among smokers, the thiocyanate test had similar rates of agreement for women(88.0%) and for men (89.3%). However, among nonsmokers, thiocyanate had higher rates of agreement for women (91.5%) than for men (85.2%). For cotinine, the rates of agreement among smokers were higher for women (91.6%) than for men (89.7%). Similarly, the rates of agreement among nonsmokers were also higher for women (93.9%) than for men (91.9%). Overall,serum cotinine had a higher concordance rate than serum thiocyanate for both men and women.

CONCLUSIONS

Although our results suggested that there were some differences in self-reporting of smoking status by gender, results were quite similar between self-reports of smoking and both biochemical tests. The results obtained from this large population-based study from two New England communities lend credibility to the use of self-reports as a low-cost accurate approach to obtaining information on smoking behaviors among both men and women in large population-based health surveys.

The relationship between hostility and behavioral risk factors for poor health in women veterans

BACKGROUND

While previous research has generally supported a relationship between hostility and health risk behaviors, the majority of this research has been conducted in predominately male, highly educated, Caucasian samples. The current study was designed to further examine the relationship between hostility and health risk behaviors in a sample of women.

METHODS

Measures of health risk behavior and scores from the Cook-Medley hostility scale were obtained from 409 women veterans. Linear and logistic regression analyses were used to examine the relationship between hostility and health behaviors including tobacco smoking, alcohol use, body-mass index, caffeine use, and level of physical activity, after sociodemographic factors were accounted for.

RESULTS

In a cohort of women veterans using VA health care, ages 35-81, hostility was significantly associated with tobacco smoking (OR = 2.10; 95% CI = 1.34 to 3.30), caffeine use (OR = 2.12; 95% CI = 1.16 to 3.85), and the number of alcoholic beverages consumed by women who drink alcohol. Hostility was not associated with body mass index (OR = 1.15; 95% CI = 0.77 to 1.72) or a lack of physical exercise (OR = 0.89; 95% CI = 0.55 to 1.43).

CONCLUSIONS

Results are generally consistent with previous research and support the relationship between hostility and health risk behaviors. Awareness that hostility contributes to risk behaviors and disease may help in the design of interventions aimed at risk reduction.