闵行区医务人员吸烟现状及参与控烟工作态度调查

目的了解闵行区医疗机构中在编员工的吸烟状况以及医务人员对病人进行控烟工作的态度,分析其成因,探索降低医疗机构在编员工吸烟率、提高医务人员参与控烟工作积极性的策略。方法对闵行区19家医疗机构全体在编员工的吸烟状况、医务人员对病人的控烟态度和控烟行为进行问卷调查。结果医疗机构在编员工总吸烟率为15.37%。其中,医务人员吸烟率为14.75%,行政人员(包括后勤人员)吸烟率为32.3%。行政人员(包括后勤人员)吸烟率明显高于医务人员吸烟率。同吸烟者相比,不吸烟者劝说病人戒烟的比例明显高于吸烟者(χ2=2090.141,P<0.01),而且,他们对在工作中加入控烟宣传的态度更为积极,行为更为主动(χ2=3164.438,P<0.01)。结论增强医疗机构在职员工对吸烟危害的认识,降低医院在编员工吸烟率;加强医务人员的基本和专业戒烟技能,促使其在日常工作中积极参与控烟工作。     

中国／WHO控烟能力建设社区子项目上海地区一年效果评估

目的　评价中国/WHO控烟能力建设合作项目(社区控烟子项目)在上海市长宁区新华街道社区居民控烟能力建设实施一年的效果,探索今后社区的控烟方法。方法　按照中国/WHO控烟能力建设合作项目(社区控烟子项目)总体安排,统一问卷、统一时间,按照人口2 %的样本量随机抽取2 0～6 0岁社区居民,对其烟草使用和控烟方面的知识、态度和行为及对戒烟服务的需求和获得情况进行了调查与分析。结果　社区男性居民吸烟率高于女性,干预前后居民吸烟率分别为35 1%和4 2 8% ,干预期间社区居民男性吸烟人群戒烟成功率为10 6 % ,以5 5岁以上年龄段、离退休人员、大专以上学历、家庭人均月收入>2 5 0 0元人群中戒烟成功率最高。戒烟失败的主要原因是缺乏意志力,其次是来自周围吸烟者的影响;84 %以上的调查对象都认为吸烟、被动吸烟有害健康,且吸烟者、不吸烟者、戒烟者正确认知率依次增高;干预后男性调查对象劝阻朋友或家人吸烟、表示戒烟后永不吸烟比干预前有明显提高(P <0 0 1) ,且能主动寻求戒烟服务(P <0 0 5 ) ;去治疗机构就医时医务人员主动向男性调查对象介绍戒烟方法和技巧干预后多于干预前(P <0 0 1) ,有显著性差异。结论　对新华街道社区居民实施控烟教育与培训等综合性措施是有效的,提升了社区居民的控烟能     

宁波市江东区街道社区卫生服务中心医务人员吸烟及控烟情况调查

[目的]了解宁波市江东区社区卫生服务中心医务人员的吸烟情况和控烟情况。[方法]随机抽样进行问卷调查,共调查了宁波市江东区各社区卫生服务中心242名医务人员。[结果]被调查对象吸烟者为29人,总吸烟率为11.98%,而男性吸烟率则为39.71%,女性吸烟率为1.15%。内科医生的吸烟率高于其他科室,高中或中专学历的吸烟率最高,吸烟的主要原因是社交需要。绝大多数医务人员(98.16%)支持无烟医院的创建,64.46%的医务人员能经常劝说吸烟的患者戒烟。不吸烟的医务人员的控烟态度明显好于吸烟者。[结论]被调查对象的吸烟率远低于全国水平,但具备的控烟知识水平较低,因此控烟工作的重点应该大力宣传和普及控烟知识。医务人员自身吸烟状况直接影响到他们的控烟的态度和行为。     

北京市区医院医务人员吸烟状况及参与控烟干预态度调查

目的 了解目前我市医务人员的吸烟状况及对参与控烟的态度及其成因，为有针对性地对医务人员这一专业群体进行戒烟培训，提高其控烟意识，促使其在日常工作中积极参与控烟工作提供依据。方法 1999年对北京市4所医院的300名医务人员进行问卷调查。结果 男性医务人员吸烟率48．1％，其中40－49岁年龄组的吸烟率明显低于其它年龄组。医务人员对有关吸烟的心脏病，糖水病，溃疡病等危害认识率不足50％。认为医务人员的戒烟建议会有效的比例占61．6％。有73．6％的医务人员愿意工作中加入戒烟内容，不吸烟者与吸烟者的态度存在显著差异。不愿意参与控烟的原因主要有：工作忙，忘记和自己本身吸烟。结论 必须加强对所有卫生专业人员进行基本的专业戒烟培训，引导医务工作者正控烟态度，把控烟视为一种职责。     

成都市医生吸烟现状及男性医生吸烟行为影响因素研究

目的了解成都市医生的吸烟状况及男性医生吸烟的影响因素。方法采用多阶段随机抽样方法,对抽取的成都市710名医生进行吸烟现状调查,应用Logistic回归模型探讨男性医生吸烟的影响因素。结果本次调查的医生总体吸烟率为17.2%,男性医生吸烟率为37.3%;男性从不吸烟者和曾经吸现在已戒烟者的相关认知均好于吸烟者(F=3.61,P0.01;F=2.98,P0.01),从不吸烟者和曾经吸现在已戒烟者的相关态度均好于吸烟者(F=2.31,P0.01;F=2.29,P0.01);男性医生吸烟的影响因素为年龄、工龄、相关知识得分、相关态度得分和单位禁烟。结论本次调查的医生吸烟率较低,男性吸烟者吸烟相关认知差于不吸烟者,应该根据调查的相关吸烟影响因素制定医院控烟措施,进一步降低医生的吸烟率。     

青海省疾病监测点成年居民吸烟、戒烟及被动吸烟状况分析

目的掌握青海省成年居民吸烟、戒烟和被动吸烟流行状况,为加强控烟教育及行为干预提供政策和科学依据。方法采用青海省"中国慢性病及其危险因素监测(2010)"调查数据,对3个国家级疾病监测点的1792名18岁及以上调查对象的吸烟和戒烟行为、被动吸烟等情况进行分析。结果调查对象的现在吸烟率和现在每日吸烟率分别为28.9%和26.3%;男性居民的现在吸烟率(62.6%)和现在每日吸烟率(56.9%)均明显高于女性(2.6%,2.4%)(P0.01);吸烟者开始每日吸烟年龄为20.7岁,日均吸烟量为14.8支;吸烟者的打算戒烟率、戒烟率和成功戒烟率分别为39.2%、19.8%和14.6%;非吸烟居民的被动吸烟率为54.1%,其中农村非吸烟居民的被动吸烟率(59.1%)高于城市(52.5%)和半农半牧地区(50.7%),女性非吸烟居民的被动吸烟率(55.6%)高于男性(49.0%),其差异均有统计学意义(P0.05)。结论青海省成年居民吸烟率和被动吸烟率都较高,而戒烟率低,各级政府和卫生行政部门应加强控烟干预和宣传,监督执行公共场所禁烟的规定,深入推进全省的控烟工作。     

天津市医生吸烟相关行为调查

目的了解天津市医生吸烟相关知识、态度和行为状况及其控烟服务的提供情况,为开展针对性的控烟工作提供依据。方法采用简单随机抽样方法抽取不同级别医院的1000名医生进行问卷调查,问卷采用中国控烟办公室统一设计的《重点人群吸烟相关行为调查问卷(医生)》,内容包括吸烟相关知识、态度、行为以及帮助吸烟者戒烟情况等。结果医生吸烟率为16.4%,男、女性吸烟率分别为37.5%,0.4%;吸烟医生的平均吸烟量为12.9支/d,且日均吸烟量随着年龄的增加而增多;非吸烟医生对吸烟相关知识的知晓率高于吸烟医生(P0.05),并且对医疗卫生机构全面控烟和为患者提供戒烟服务的态度也更为积极和认可(P0.05)。结论与全国水平相比,天津市医生吸烟率和平均吸烟量较低,但仍需采取措施进一步促进医生吸烟行为的转变。     

成都市医务人员吸烟调查

目的了解成都市医务人员吸烟状况及控烟能力。方法 2009-04/05在指定的成都市15家医疗卫生机构中采用卫生部统一编制的＂医疗卫生机构人员调查表＂调查医生吸烟情况,与吸烟相关的知识和态度,以及帮助吸烟者戒烟能力调查。结果本次共调查1 176名医务人员,医生吸烟率13.4%（其中男性医生吸烟率40.0%,女性0.5%）,调查发现医务人员对吸烟危害掌握不全面,但多数人员积极支持室内全面禁烟。结论 在对医务人员进行控烟健康教育的时候必须强调戒烟知识和传授戒烟方法,以便在工作和生活中运用。     

天津市居民吸烟及戒烟状况调查分析

目的：了解天津市居民吸烟状况、戒烟想法及戒烟方法的应用,为有针对性地在居民中开展健康教育活动提供依据,同时为制定相关控烟政策提供基础数据。方法使用 PPS 法(按规模大小成比例的概率抽样)在每个区抽取3个街道,共计16个区。使用 PPS 在每个街道抽取2个居委会抽样单位,采用随机抽样方法在每个居委会抽取70个家庭户,每个家庭户采用 KISH 表抽取1名调查对象,每个居委会完成50份调查问卷。结果男性现在吸烟率为42.35%,女性现在吸烟率为10.32%,男性吸烟率高于女性(χ2=760.956,P <0.05),不同文化程度居民吸烟率差异有统计学意义(χ2=95.605,P <0.05)。男性与女性现在吸烟者戒烟意愿差异无统计学意义(χ2=2.959,P >0.05),不同吸烟量的现在吸烟者戒烟意愿差异有统计学意义(χ2=30.434,P <0.05),随着吸烟者吸烟量的增大,想戒烟的比例也在逐渐降低。89.18%现在吸烟者选择靠自己毅力戒烟,7.06%选择拨打戒烟热线。在过去12个月,有42.25%医护人员建议吸烟者戒烟。非吸烟者对主动吸烟及吸入二手烟的危害知晓率高于吸烟者,有戒烟想法的人主动吸烟及吸入二手烟的危害知晓率高于吸烟者。结论应积极开展控烟工作,有针对性地对男性、女性吸烟者开展控烟干预工作,加大戒烟门诊、戒烟热线的宣传,提高医务人员的戒烟知识和戒烟技巧,广泛宣传主动吸烟与被动吸烟的危害,同时政府部门加强控烟法律执行力度,保证人民群众不受二手烟的危害。     

城市社区居民控烟能力现状分析

目的　调查城市社区居民控烟能力现况。方法　根据多阶段随机抽样的方法 ,在两个抽中社区里选中 1 2个居委会 ,根据人口 2 %的样本量随机抽取 2 0岁以上居民进行控烟状况调查。以问卷的方式共调查居民3 878人。结果　通过这次基线调查 ,显示我市城市社区居民吸烟人群戒烟失败的主要原因是缺乏意志力( 45 9% )和来自周围吸烟环境者的影响 ( 2 4 4% ) ;控烟的行为较低 ,其中现在主动寻求戒烟服务率、尝试戒烟率、劝阻朋友或家人吸烟率等分别为 2 1 6%、 2 0 3 %、 3 8 6%。居民对吸烟影响健康的知识了解不全面 ,吸烟对健康有害、被动吸烟对健康有害的回答正确率均在 90 %左右 ,但同时认为吸烟者比不吸烟者更易得肺癌、气管炎、冠心病的相关知识回答正确率不到 3 0 %。结论　主动寻求戒烟服务率、尝试戒烟率、劝阻朋友或家人吸烟率仍很低。居民对吸烟危害健康的知识了解不全面 ,应加强综合控烟措施     

徐州市2008年15岁及以上常住居民吸烟与被动吸烟现状调查

目的 了解徐州市不同人群吸烟现状,为开展控烟工作提供依据.方法 于2008年6-12月采用多阶段分层随机抽样方法 ,选择具有代表性的样本,对15岁及以上常住居民,采用统一调查问卷进行调查.结果共调查44 686人,其中城市10 295人(23.04%),农村34 391人(76.96%);男性21 524人(48.17%),女性23 162人(51.83%).15岁及以上人群吸烟率、现在吸烟率、常吸烟率、重型吸烟率、平均每日吸烟量、戒烟成功率、复吸率及被动吸烟率分别为22.45%、21.40%、15.49%、9.49%、15.09支、4.68%、5.91%和14.12%.城乡居民的吸烟率、现在吸烟率、常吸烟率差异无统计学意义(P>0.05);戒烟成功率、被动吸烟率城市高于农村(P<0.05);复吸率、重型吸烟率、平均每日吸烟量农村高于城市(P<0.05).男性吸烟率、现在吸烟率、常吸烟率、重型吸烟率、复吸率、平均每日吸烟量比例均高于女性(P<0.05).戒烟成功率、被动吸烟率女性高于男性(P<0.05).该人群吸烟者中主要吸有过滤嘴香烟(85.17%).不同文化程度、职业、经济收入的人群吸烟率比较,经X~2检验,差异均有统计学意义(P<0.05).结论 徐州市居民中吸烟率仍然很高,应采取有针对性的措施,有效地控制烟草的流行.     

Tobacco usage in France: An epidemiological study

A survey of tobacco and alcohol consumption was conducted among 3,453 noninstitutionalized men and women in 65 départements in France. Over four-fifths of the men and half of the women surveyed had smoked cigarettes. Men were far more likely than women to have stopped smoking, especially older men in higher social classes. Fifty-five percent of the men smoked cigarettes made with black tobacco (Gauloises, Gitanes), while women preferred blond tobacco products. Younger smokers of both sexes preferred filtered cigarettes, while older respondents smoked nonfiltered ones. Filter usage among men, but not women, increased with education. Inhalation was more prevalent among men than women, among the young than the old, and among the more educated than the less educated. “Drooping” or carrying a lighted cigarettes in the mouth without inhaling, was a practice more common in older, less educated male smokers. These data also provide some evidence in support of the hypothesis that black tobacco, with its higher pH, provides unprotonated nicotine which is easily absorbed by oral mucosa, thus making deep inhalation of the smoke less important to the smoker. The observed differences between the smoking practices of the French and those in the United States and United Kingdom along with the relatively higher alcohol consumption noted throughout France, may partially explain the lower rates of lung cancer and higher rates of larynx, esophagus, and oral cavity cancer found in French men.     

Serum bilirubin concentration in a Belgian population: the association with smoking status and type of cigarettes

BACKGROUND: The endogenous antioxidant serum bilirubin may scavenge free radical species from cigarette smoke. Smokers are expected to have lower serum bilirubin levels than never smokers, but this has never been evaluated in a random population sample of women and men. In addition, in vitro studies indicate that filter cigarette smoke might enhance bilirubin oxidation more than non-filter cigarette smoke. METHODS: In this paper, data were analysed from the Belgian Interuniversity Research on Nutrition and Health (BIRNH) study. We investigated the association of smoking and type of cigarettes with serum bilirubin concentrations in men and women using multiple regression models taking into account differences in baseline and smoking characteristics. RESULTS: In men, current smokers had lower crude and adjusted serum bilirubin concentrations compared with never smokers (P = 0.0001). For women, the association between smoking and serum bilirubin concentrations adjusted for age was in the same direction as for men, but did not reach statistical significance. Male former smokers had serum bilirubin concentrations in between those of current smokers and never smokers, while female former smokers had even higher (+ 0.50 micromol/l) serum bilirubin concentrations than never smokers. Male subjects smoking filter cigarettes showed a higher serum bilirubin concentration than those smoking cigarettes without a filter (adjusted difference: 0.49 micromol/l; P = 0.03). The duration of smoking was inversely and significantly related to serum bilirubin concentrations (P = 0.0003). CONCLUSION: Smoking may lower serum bilirubin concentrations in men, especially in those smoking non-filter cigarettes. The duration of smoking is a more important determinant for serum bilirubin concentrations than the number of cigarettes smoked per day, which may indicate the cumulative negative effects of smoking on the endogenous antioxidant system. Results for females pointed in the same direction, but were less clear, possibly due to low numbers of smoking women, who were largely young and smoked mainly filter cigarettes for a shorter period of time.     

Characteristics of tobacco smoking in schools in Andorra]

1600 schoolchildren aged 13 to 18 answered an anonimus, self administered questionnaire, in a cross sectional study to estimate the prevalence of cigarette smoking in the high grades schools in Andorra. 46.6% answered they did smoke cigarettes, either daily (11.2%) or occasionally (35.4%). Ten per cent of actual smokers did already smoke at age 10, and 50% at age 13. More girls (48.8%) than boys (44.4%) smoked (p less than 0.05) but boys smoked a greater number of cigarettes (p less than 0.001). Ninety five percent smoked Virginia tobacco, and little more than 50% used filter tipped cigarettes. Two thirds of smokers inhaled the smoke of cigarettes; this was more common among daily smokers. Again two thirds of smokers answered they would be prepared to quit smoking. 31% of those who had tried smoking said they believed they would smoke in the future, while only 5.6% of those that never smoked previously said so (p less than 0.001). Actual smokers answered they believed that they would not smoke in the future much less often than non smokers. Parents let boys smoke more than girls when the children started doing so, particularly before age thirteen and after age fifteen. These are the first available data about the community studied describing some features of its cigarette smoking habit. Their knowledge may well help to plan disease protection and health promotion developments addressed to youngsters in Andorra.     

Sex differences in prevalence rates and predictors of cigarette smoking among in-school adolescents in Kilimanjaro, Tanzania

An analysis of the Global Youth Tobacco Survey for Kilimanjaro, Tanzania was carried out to assess sex differences in the prevalence rates and predictors of current cigarette smoking among in-school adolescents. A total of 2323 adolescents participated in the study of whom 53% were females and 47% males. The prevalence of current cigarette smoking was 3.0% and 1.4% among males and females, respectively. The common factors that were significantly positively associated with cigarette smoking between sexes were: having more pocket money, closest friend smoked cigarettes, seeing actors smoke on TV, videos or movies, and seeing advertisements for cigarettes at social gatherings. Seeing anti-smoking messages at social gatherings were negatively associated with smoking among both sexes. While having had something such as a t-shirt or pen with a cigarette brand logo on it was positively associated with cigarette smoking among males, it was negatively associated with cigarette smoking among females. Male adolescents older than 15 years, those in their 9th year of schooling, and those who had seen cigarette brand names on TV were more likely to smoke. Meanwhile, male respondents who were in their 8th year of schooling, had seen anti-smoking media messages, and advertisements for cigarettes in newspapers or magazines were less likely to smoke. Among female adolescents, those who had parents who smoked, and surprisingly those who perceived that cigarette smoking as harmful were more likely to smoke. Interestingly, seeing advertisement for cigarettes on billboards was negatively associated with smoking among female adolescents. Interventions aimed to reduce adolescent smoking need to be designed and implemented with due consideration of sex differences in these associated factors.     

Smoking and alcohol consumption in a UK Chinese population

Little research has been conducted on health in Chinese communities in the UK and there are few representative data on smoking, alcohol consumption or other aspects of lifestyle. We undertook a cross sectional population-based study of 380 Chinese and 625 European men and women aged 25 to 64 y, using self-completion and interview questionnaires in Newcastle upon Tyne, UK between 1991 and 1995. We measured self-reported prevalence of cigarette smoking, number of cigarettes smoked per week and age at starting smoking; self-reported prevalence of alcohol consumption and units of alcohol consumed per week. In age-adjusted comparisons smoking was less common in Chinese (24%) than European men (35%) (P=0.00002) and among Chinese (1%) compared with European women (33%) (P<0.00001). Number of cigarettes smoked was similar among Chinese and European male smokers. Median age at starting smoking was higher among Chinese (18.5 y) compared with European men (15 y) (P=0.00001). Smoking was commonest in older Chinese and in younger Europeans.The prevalence of alcohol consumption was lower among Chinese (63%) than European men (93%) (P<0.00001) and among Chinese (29%) compared to European women (89%) (P<0.00001). Median alcohol consumption was significantly lower among Chinese (2 units/week) than European men (16 units/week) (P<0.00001), and among Chinese (1 unit/week) compared to European women (6 units/week) (P<0.00001). Among those who drank alcohol, Chinese men were less likely to drink above recommended limits than European men (1% vs 39%; P<0.00001). Chinese men and women currently have relatively favourable patterns of smoking compared to European adults in Newcastle. Average alcohol consumption among Chinese who drink is lower than among Europeans, and a substantial proportion of the Chinese population in Newcastle drink no alcohol. Patterns of health related behaviour should be tracked over time in ethnic minority populations to identify changes that pose risk to health and which deserve appropriate intervention.     

Tobacco Price Increase and Smoking Cessation in Japan,a Developed Country With Affordable Tobacco: A National Population-Based Observational Study

Background

Longitudinal assessment of the impact of tobacco price on smoking cessation is scarce. Our objective was to investigate the effect of a price increase in October 2010 on cessation rates according to gender, age, socioeconomic status, and level of tobacco dependence in Japan.

Methods

We used longitudinal data linkage of two nationally representative studies and followed 2702 smokers for assessment of their cessation status. The odds ratios (ORs) for cessation were calculated using logistic regression. To estimate the impact of the 2010 tobacco price increase on cessation, data from 2007 were used as a reference category.

Results

Overall cessation rates significantly increased from 2007 to 2010, from 3.7% to 10.7% for men and from 9.9% to 16.3% for women. Cessation rates were 9.3% for men who smoked 1–10 cigarettes per day, 2.7% for men who smoked 11–20 cigarettes per day, and 2.0% for men who smoked more than 20 cigarettes per day in 2007. These rates increased to 15.5%, 10.0%, and 8.0%, respectively, in 2010. The impact was stronger among subjects who smoked more than 11 cigarettes per day than those who smoked 1–10 cigarettes per day in both sexes: ORs for 2010 were 4.04 for those smoking 11–20 cigarettes per day, 4.26 for those smoking more than 20 cigarettes per day, and 1.80 for those smoking 1–10 cigarettes per day in the main model in men. There were no obvious differences in the relationship between tobacco price increase and smoking cessation across age and household expenditure groups.

Conclusions

The tobacco price increase in Japan had a significant impact on smoking cessation in both sexes, especially among heavy smokers, with no clear difference in effect by socio-demographic status.Key words: tobacco price increase, smoking cessation, Japan, linkage study     

What determines mortality risk in male former cigarette smokers?

OBJECTIVES. The purpose of this study was to examine what factors determine the mortality experience of male ex-cigarette smokers, those who no longer smoke at all and those who changed to pipe or cigar smoking. METHODS. A cohort study was undertaken with 18-year mortality data on 19,018 men. RESULTS. Ex-cigarette smokers had an intermediate mortality risk compared with never and current smokers. Ex-cigarette smokers who switched to pipe smoking had higher mortality than those who no longer smoked at all. The mortality rates for pipe and cigar smokers who were former cigarette smokers were higher than those for pipe or cigar smokers who had never smoked cigarettes. Ex-cigarette smokers who consumed more than 20 cigarettes per day for more than 20 years experienced increased mortality for both coronary heart disease and neoplasms, even after 30 years of cessation. CONCLUSIONS. These results support the notion that an elevated mortality risk may be seen for ex-cigarette smokers, even after they have given up smoking for many years. Ex-cigarette smokers who change to a pipe have a greater mortality risk than those who no longer smoke at all.     

吸烟心理动机调查分析

In a survey on the prevalence and motivation of smoking among 1,455 male officers and soldiers in the army, navy and air force in Shanghai area in June, 1986, it was found that 330 subjects in 638 current smokers and 57 ex-smokers (47.5%) started smoking on account of needs of social inter course. The proportion of smokers beginning to smoke before 19 years of age was much greater than that after 20 years for reasons of imitation (P less than 0.001), and the latter was greater than the former for reasons of stimulation (0.05 greater than P greater than 0.01). Smokers who started to smoke before 19 years of age became tobacco addicted more easily than those after 20 years (P less than 0.001), and the former were more easily entice to smoke for passing time, tranquil effect, and imitation. The median age of initiating smoking was 20.6 years of age for 638 smokers, and 84.2% of them started to smoke between 15 and 24 years of age.     

Evidence for compensation in smokers of low yield cigarettes

To determine the relation of smoking low yield cigarettes (tar yield less than 15.0 mg and nicotine yield less than 1.0 mg per cigarette) to the number of cigarettes smoked per day, we analysed information provided on self-administered questionnaires by 7706 current, regular cigarette smokers. The mean age at starting to smoke and the mean number of years of smoking were not consistently different in smokers of low yield compared with smokers of high yield cigarettes. In contrast, at all ages in both men and women, smokers of low yield cigarettes smoked significantly more cigarettes per day than smokers of high yield cigarettes. The differences in the number of cigarettes smoked per day between smokers of low and high yield cigarettes were small--about 3 cigarettes per day in men and about 1 1/2 cigarettes per day in women. However, these small differences might translate to the smoking of as many as one billion more packs of cigarettes per year in the United States alone. The potential beneficial effect of the smoking of cigarettes whose yield per cigarette is lower must be weighed against a possible adverse effect of the smoking of more cigarettes if the relation between smoking low yield cigarettes and smoking more cigarettes is causal.