A comparison of smoking and drinking behaviours in pregnant women: who abstains and why

Changes in alcohol and nicotine usage during pregnancy are reported for a sample of 112 pregnant women, 35 of whom smoked cigarettes before pregnancy and 86 of whom drank alcohol before pregnancy. Striking differences were observed among the patterns of cigarette smoking compared with those of drinking. One hundred per cent of drinkers reported a reduced intake of alcohol but only 57% of the smokers reported a decrease in cigarette smoking. Forty per cent of the smokers reported that they had "tried and failed" to cut down on their cigarette consumption yet none of the drinkers reported such a failure. A reduction in drinking during pregnancy was related directly to an antenatal emotional attachment to the fetus and related inversely to feelings of irritability towards the fetus. In the case of smoking, this relationship did not emerge, and it seemed probable that a psychological and a physiological dependence on nicotine may override the effect of an emotional attachment to the fetus. Implications for the prevention of smoking are discussed.     

The role of cigarettes and nicotine in the onset and treatment of ulcerative colitis.

Epidemiological evidence suggests that ulcerative colitis is a disease of nonsmokers, while Crohn''s disease is a disease of smokers. The relative risk of developing ulcerative colitis is not only greater in nonsmokers, in addition there appears to be a rebound effect in smokers who quit, with the heaviest (ex-)smokers increasing their relative risk of the disease the most. This factor poses an ethical dilemma for health professionals giving advice on stopping smoking, which may thus have a serious detrimental effect on the health of some patients. Nicotine is believed to be the pharmacological ingredient of tobacco that is responsible for this beneficial effect and several clinical trials using nicotine have demonstrated it to be an effective therapeutic agent in the treatment of ulcerative colitis. Although the aetiology of ulcerative colitis is unclear, current research using nicotine-based products has produced some interesting clues, together with the possibility of some form of therapeutic treatment based on nicotine administration.     

我国吸烟者尼古丁依赖状况及影响因素调查

目的：了解吸烟者的吸烟行为及其对烟草的依赖程度和影响因素。方法：采用方便抽样方法收集北京等5个地方1000名吸烟者的资料，用尼古丁依赖评估量表测量其依赖程度，多元Logistic回归筛选影响因素。结果：首次吸烟年龄均值为20岁，累计吸烟年限均值为14．07年，尼古丁依赖得分均值为3．89分。多元Logistic回归分析中，影响吸烟者尼古丁依赖度偏高的因素有常住地为河北、工作高度紧张、吸烟25年以上及不知道吸烟有害，而受教育程度为本科及以上的吸烟者尼古丁依赖程度较低。结论：吸烟者尼古丁依赖程度与常住地、受教育程度、工作压力、累计吸烟时间和健康意识等因素有关，加强控烟健康教育有利于降低吸烟者对尼古丁的依赖。     

Trends in pregnancy-related smoking rates in the United States, 1987-1996

CONTEXT: Rates of smoking are increasing among adolescents and young adults, but trends in smoking among pregnant women have not been studied. OBJECTIVE: To assess pregnancy-related variations in smoking behaviors and their determinants among women of childbearing age in the United States. DESIGN: Analysis of data collected between 1987-1996 from the Behavioral Risk Factor Surveillance System survey. SETTING AND SUBJECTS: A total of 187302 (178499 nonpregnant and 8803 pregnant) noninstitutionalized women aged 18 to 44 years from 33 states. MAIN OUTCOME MEASURES: Prevalence rates of smoking initiation and current smoking, median number of cigarettes smoked, and adjusted odds ratios for smoking stratified by pregnancy status; prevalence rate ratio for current smoking comparing pregnant with nonpregnant women. RESULTS: The overall percentage of women who had ever initiated smoking decreased significantly from 44.1% in 1987 to 38.2% in 1996. During that 10-year period, the prevalence of current smoking also decreased significantly among both pregnant women (16.3% to 11.8%) and nonpregnant women (26.7% to 23.6%). Overall, pregnant women were about half (54%) as likely as nonpregnant women to be current smokers during 1987-1996. Over time, the median number of cigarettes smoked per day by pregnant smokers remained at 10, whereas among nonpregnant smokers it decreased from 19 to 15 (P<.05 for trend). In the same period, among young women (aged 18-20 years), prevalence rates of smoking initiation and current smoking increased slightly. Sociodemographic subgroups of women at increased risk for current smoking were the same for pregnant and nonpregnant women (ie, those with a completed high school education or less, whites, and those who were unmarried). CONCLUSIONS: In this analysis, the decline in smoking over time among pregnant women was primarily due to the overall decline in smoking initiation rates among women of childbearing age, not to an increased rate of smoking cessation related to pregnancy. To foster effective perinatal tobacco control, efforts are needed to further reduce the number of young women who begin smoking. Clinicians should query all pregnant women and women of childbearing age about smoking and provide cessation and relapse interventions to each smoker.     

Behavioral and pharmacological treatment methods for pregnant smokers: issues for clinical practice

Active and passive exposure to tobacco smoke are the most serious and preventable causes of poor maternal, fetal, and infant outcomes in the United States. Unfortunately, the majority of pregnant smokers do not quit smoking before or during pregnancy or after childbirth. We describe a standardized behavioral counseling model and discuss issues to consider in recommending the use of pharmacotherapy during pregnancy. Although the Food and Drug Administration no longer classifies nicotine replacement therapy (NRT) as contraindicated during pregnancy, precautions should be carefully considered for use in this population. This paper provides a synopsis of the risks of exposure to tobacco smoke during pregnancy and the postpartum; estimates the population at risk and the potential for increased cessation if effective health education methods during pregnancy were routinely provided; presents a meta-analysis of "best practice" patient education methods for pregnant smokers; and estimates the number of pregnant heavy smokers who might be eligible for NRT. We suggest five issues for the physician to consider before recommending NRT medications to pregnant patients who are heavy smokers. The judicious use of NRT medications may significantly reduce harm to the infants of heavy smokers. More evidence derived from large population-based research, however, is needed to provide guidance to the physician about NRT eligibility, dose, scheduling, and effectiveness in clinical practice.     

中国大学生吸烟行为和吸烟态度研究

目的:对我国大学生的吸烟现状进行调查;并检验“吸烟态度与吸烟行为具有一致性”的假设。方法:用问卷法对805名中国大学生进行了研究。结果:大学生中有19.1％的人为当前吸烟者;男生吸烟普遍性显著高于女生;吸烟的普遍性随着年级的增高而增高;大学生对尼古丁没有依赖性;不吸烟者抗烟态度强,吸烟者抗烟态度弱。结论:吸烟态度与吸烟行为具有一致性。     

Quitting smoking in pregnancy

Smoking doubles the risk of having a low-birthweight baby and significantly increases the rate of perinatal mortality and several other adverse pregnancy outcomes. The mean reduction in birthweight for babies of smoking mothers is 200 g. High quality interventions to help pregnant women quit smoking produce an absolute difference of 8.1% in validated late-pregnancy quit rates. If abstinence is not achievable, it is likely that a 50% reduction in smoking would be the minimum necessary to benefit the health of mother and baby. Healthcare providers perform poorly in antenatal interventions to stop women smoking. Midwives deliver interventions at a higher rate than doctors. The efficacy of nicotine replacement therapy has not been established in pregnancy. Currently, its use should only be considered in women smoking more than 10 cigarettes per day who have made a recent, unsuccessful attempt to quit and who are motivated to quit. Relapse prevention programs have shown little success in the postpartum period.     

戒烟药物的研究和应用进展

吸烟是引发许多疾病的重要危险因素,戒烟是减少烟草相关疾病的重要手段。戒烟药物有助于吸烟者戒烟。常用一线戒烟药物包括尼古丁替代疗法（NRT）制剂、安非他酮缓释制剂和伐尼克兰。该文对以上戒烟药物的研究和应用进展进行综述。     

Considerations for smoking advice in pregnancy

Cigarette smoking in pregnancy was the single most important preventable factor identified when determinants of birth weight were studied in 375 pregnancies. Current professional intervention was not effective in reducing cigarette consumption in pregnancy in these mothers in Londonderry, of whom only 19 (5%) became ex-smokers. Present health education, which emphasises impaired fetal growth and wellbeing, had its greatest effect amongst primigravid smokers of whom 32% made some reduction in cigarette consumption. Maternal expectation of birth weight differed significantly between non-smokers, light to moderate, and heavy smokers (8.2 lb, 7.9 lb, 7.3 lb respectively). 54% of multiparous smokers expected the birth weight to be similar to the birth weight in previous pregnancies. Of the women who reduced smoking, 57% did so for the baby, 23% because they found the habit less pleasurable during pregnancy and 13% because of professional advice. Maternal expectation of birth weight is one factor which negates the slant of current health education advice in pregnancy. An anti-smoking programme aimed at protecting the fetus from the harmful effects of cigarettes may produce optimal results when targeted at primary school-aged children in whom the smoking habit is less firmly established.     

Nicotine chewing gum in general practice: effect of follow up appointments

Two hundred smokers who were judged by their general practitioner to be motivated to stop smoking were allocated to one of two groups. All were offered an initial appointment at which they were advised to stop smoking and offered nicotine gum. One group then received no further appointments. The other was offered four further appointments over three months. Both groups were followed up at six and 12 months. At one year follow up 15.5% overall had stopped smoking, 14% in the low and 17% in the high contact group. This is better than most results so far reported for nicotine chewing gum in general practice, suggesting that general practitioners can use it to good effect. We compare this result with others achieved in general practice.     

Antismoking products

Nicotine is the addictive substance in tobacco and its withdrawal is responsible for a range of unpleasant symptoms after smoking cessation. Although it produces acute physiological effects, nicotine alone is not carcinogenic and does not appear to cause the vascular disease associated with smoking. Nicotine replacement has been shown to be a safe and effective pharmacological treatment for tobacco dependence in certain smokers. Its efficacy is greatest when prescribed for those who are motivated and highly nicotine-dependent. It is probably not indicated for smokers with a low degree of nicotine dependence. Studies of nicotine chewing gum conducted in special referral clinics have generally produced positive results, whereas those conducted in community practice settings have shown a smaller benefit when compared with placebo. When the results of all published placebo-controlled trials are pooled the typical improvement in smoking cessation rate is 40% (odds ratio continued smoking 0.6; 95% confidence interval 0.5-0.71; P less than 0.00001). The best results with nicotine chewing gum have been obtained with multicomponent programmes which have included some counselling and ongoing follow up and support. Early reports of success with a transdermal nicotine preparation suggest that it may have similar efficacy to nicotine gum. Clonidine administered orally or transdermally has also been shown to reduce tobacco withdrawal symptoms but requires more convincing evidence of long-term efficacy before it can be recommended for routine use. Currently available over-the-counter products, apart from nicotine chewing gum, have not been shown to be effective.     

Current smoking trends in the United States. The 1981-1983 behavioral risk factor surveys

Based on the aggregate of behavioral risk factor surveys, almost one third of adults were smokers in 1982. Overall, significantly fewer Hispanics smoked compared with whites or blacks. Among young adults, however, the rate of smoking was highest among whites compared with blacks and Hispanics. Compared with nonsmokers, smokers--especially young women--had higher rates of other risk behaviors, including alcohol misuse and lack of seat-belt use. Since 1965, the rate of decline of smoking among women has not been as great as that among men, due in part to the high rate--more than 40%--of smoking among young white women. Despite continued decrease in the overall proportion of smokers, the high rate among young women emphasizes the need for continued efforts toward prevention and cessation, before the well-documented health consequences develop.     

Smoking and myocardial infarction: secondary prevention

This prospective study examines the question ''Is it too late to stop smoking cigarettes once you have had a myocardial infarction?'' One hundred and nineteen cigarette smokers (90 men, 29 women) who survived their first myocardial infarction for one month were followed for five years or until their death if earlier. The age corrected mortality rate of men who continued to smoke cigarettes was 2.2 times the age corrected mortality rate of those who stopped smoking after their infarct. The women who continued to smoke had 2.4 times the age corrected mortality of those who stopped smoking. The age and sex corrected mortality rates for the combined group of men and women show that those who stopped smoking after their infarction have 55% of the mortality of those who continued to smoke (P less than 0.05). These results suggest that smoking is not merely a ''risk factor'' for myocardial infarction but is also a causal factor whose effects can be avoided by both men and women after an initial myocardial infarction.     

The pharmacotherapy of smoking cessation

1. The great majority of smokers are chronically dependent on tobacco. This dependence arises from the rituals and sensory associations of smoking that are reinforced, within seconds, by a rapid burst of nicotine from the cigarette. 2. All forms of nicotine replacement therapy (NRT) -- gum, patches and inhaler -- and bupropion are safe and effective for increasing smoking cessation rates in the short and long terms. 3. Other than those who are minimally dependent, all patients willing to quit should be offered one of these therapies unless contraindications exist. The effectiveness of drug treatments is multiplied when associated with effective counselling or behavioural treatments. 4. While NRT is not recommended during pregnancy or in patients with cardiac disease, if the alternative is smoking NRT is almost certainly safe. 5. Combination NRT (more than one therapy) may be indicated in patients who have failed monotherapy in association with withdrawal symptoms. 6. There are some specific contraindications to the use of bupropion. Its subsidised availability should not influence prescribers to ignore these.     

吸烟对血浆尿酸水平的影响

目的 测定吸烟对血浆尿酸的影响及其与烟草代谢物的关系.方法 选取健康体检者300例,其中吸烟者162例（男性145例,女性17例）,不吸烟者138例（男性62例,女性76例）,测定血浆尿酸、肌酐以及尿可替宁水平.结果 吸烟者血浆尿酸水平较不吸烟者明显降低,差异有统计学意义.血浆尿酸水平与吸烟量、吸烟时间呈负相关.结论 在排除影响血浆尿酸的因素以后,吸烟者尿酸水平较不吸烟者明显降低,且这种降低与尿酸内源性生成减少有关,是吸烟促发人体应激反应作用的结果.由于血浆尿酸测定方法简单,而且能反映人体的抗氧化物水平,因此它有可能作为了解吸烟应激状态的常规测定指标.     

Preventing and treating nicotine addiction: a review with emphasis on adolescent health

This article is the fourth in a series of four providing current, state-of-the-art information about the tobacco problem and how physicians can effectively intervene. The articles review the health effects of second-hand smoke, current treatment strategies for nicotine addiction and the implementation of best practices, such as the "5 As," to effectively intervene with families with smokers. Three of the articles are accredited for free continuing medical education (CME) credit for physicians. To obtain AMA PRA Category 1 Credit(s)TM for this article, please go online to www.PedsEducation.org, your source for free continuing medical education from Nemours. Choose "Online Education" and the article, and complete the post-test as directed. CME accreditation for this educational presentation is provided at no cost as a service of Nemours, one of the nation's largest children's health systems. Nemours is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Nemours designates this educational activity for a maximum of .5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. This article will focus on the prevention of adolescent smoking and discuss a global approach to the tobacco problem among youth. It also reviews the rationale for and pharmacology of treating nicotine addiction to empower physicians to assist smokers with quitting. By reading the article and completing the post-test, it is anticipated that the following learning objectives will be met: Physicians will become familiar with: 1) Options for treating nicotine addiction, 2) The unique aspects of the tobacco problem in adolescence, 3) The risk factors for teen smoking initiation.     

Association of nicotinic acetylcholine receptor subunit alpha-4 polymorphisms with smoking behaviors in Chinese male smokers

Background  It has been reported that the nicotinic acetylcholine receptor subunit α4 gene (CHRNA4) might be associated with smoking behaviors in the previous studies. Up to now, there are few reports on the relationship between CHRNA4 and smoking initiation. In this study, we tried to explore the role of two polymorphisms in CHRNA4 (rs1044396 and rs1044397) in smoking initiation and nicotine dependence in Chinese male smokers.

Methods  Nine hundred and sixty-six Chinese male lifetime nonsmokers and smokers were assessed by the Fagerström test for nicotine dependence (FTND), smoking quantity (SQ) and the heaviness of smoking index (HSI). All subjects were divided into four groups based on their tobacco use history and the FTND scores. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was performed to find two polymorphisms of CHRNA4 in these subjects.

Results  The χ² test showed that rs1044396 was significantly associated with smoking initiation (χ²=4.65, P=0.031), while both rs1044396 and rs1044397 were significantly associated with nicotine dependence (χ²=5.42, P=0.020; χ²=7.58, P=0.005). Furthermore, the T-G (3.9%) haplotype of rs1044396-rs1044397 showed significant association with smoking initiation (χ²=6.30, P=0.012) and the C-G haplotype (58.9%) remained positive association with nicotine dependence (χ²=8.64, P=0.003) after Bonferroni correction. The C-G haplotype also significantly increased the HSI (P=0.002) and FTND scores (P=0.001) after Bonferroni correction.

Conclusion  These findings suggest that CHRNA4 may be associated with smoking initiation and the C-G haplotype of rs1044396-rs1044397 might increase the vulnerability to nicotine dependence in Chinese male smokers.

     

Association of nicotinic acetylcholine receptor subunit alpha-4 polymorphisms with smoking behaviors in Chinese male smokers

Background It has been reported that the nicotinic acetylcholine receptor subunit a4 gene (CHRNA4) might be associated with smoking behaviors in the previous studies. Up to now, there are few reports on the relationship between CHRNA4 and smoking initiation. In this study, we tried to explore the role of two polymorphisms in CHRNA4 (rs 1044396 and rs 1044397) in smoking initiation and nicotine dependence in Chinese male smokers.Methods Nine hundred and sixty-six Chinese male lifetime nonsmokers and smokers were assessed by the Fagerstr(o)m test for nicotine dependence (FTND), smoking quantity (SQ) and the heaviness of smoking index (HSI). All subjects were divided into four groups based on their tobacco use history and the FTND scores. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was performed to find two polymorphisms of CHRNA4 in these subjects.Results The x2 test showed that rs1044396 was significantly associated with smoking initiation (x2=4.65, P=0.031),while both rs1044396 and rs1044397 were significantly associated with nicotine dependence (x2=5.42, P=0.020; x2=758,P=0.005). Furthermore, the T-G (3.9%) haplotype of rs1044396-rs1044397 showed significant association with smoking initiation (x2=6.30, P=0.012) and the C-G haplotype (58.9%) remained positive association with nicotine dependence (x2=8.64, P=0.003) after Bonferroni correction. The C-G haplotype also significantly increased the HSI (P=0.002) and FTND scores (P=0.001) after Bonferroni correction.Conclusion These findings suggest that CHRNA4 may be associated with smoking initiation and the C-G haplotype of rs1044396-rs1044397 might increase the vulnerability to nicotine dependence in Chinese male smokers.     

Heavy smokers, smoking cessation, and clonidine. Results of a double-blind, randomized trial

Seventy-one heavy smokers who had failed in previous attempts to stop smoking participated in a randomized clinical trial to test the efficacy of clonidine as an aid in smoking cessation. The success rate in clonidine-treated subjects (verified by serum cotinine concentration) was more than twice that in the placebo-treated subjects. When the data were stratified by gender, a strong effect present in women was not apparent in men. After six months, cessation rates remained significantly higher among smokers treated with clonidine than those receiving placebo. The data also revealed an unexpectedly high prevalence (61%) of a history of major depression in this sample and a significant negative effect of such a history on cessation regardless of treatment. These findings, highly suggestive of an important role of clonidine in smoking cessation, warrant further studies to establish the long-term (greater than or equal to 12 months) efficacy of this drug and to replicate the association between nicotine dependence and depression.     

Reduced tar, nicotine, and carbon monoxide exposure while smoking ultralow- but not low-yield cigarettes

An unresolved public health issue is whether some modern cigarettes are less hazardous than others and whether patients who cannot stop smoking should be advised to switch to lower-yield cigarettes. We studied "tar" (estimated by urine mutagenicity), nicotine, and carbon monoxide exposure in habitual smokers switched from their usual brand to high- (15 mg of tar), low- (5 mg of tar), or ultralow-yield (1 mg of tar) cigarettes. There were no differences in exposure comparing high- or low-yield cigarettes, but tar and nicotine exposures were reduced by 49% and 56%, respectively, and carbon monoxide exposure by 36% while smoking ultralow-yield cigarettes. Similarly, in 248 subjects smoking their self-selected brand, nicotine intake, estimated by blood concentrations of its metabolite cotinine, was 40% lower in those who smoked ultralow but no different in those smoking higher yields of cigarettes. Our data indicate that ultralow-yield cigarettes do deliver substantial doses of tar, nicotine, and carbon monoxide, but that exposures are considerably less than for other cigarettes.