Facial wrinkling in men and women, by smoking status.

OBJECTIVES. This study examined the association of smoking status and pack-years of smoking with facial wrinkling in men and women. METHODS. We conducted a cross-sectional study of 299 never smokers, 551 former smokers and 286 current smokers, aged 30 through 69 years, drawn from a health maintenance organization. Smoking status, pack-years of smoking, and potential confounding variables were assessed by questionnaire. Facial wrinkle category, a dichotomous variable, and facial wrinkle score, a computed continuous variable, were assessed by blinded standardized visual assessment. Wrinkling was so uncommon among 30- through 39-year-old subjects that analyses were restricted to subjects aged 40 and over (227 never smokers, 456 former smokers, and 228 current smokers). RESULTS. With age, average sun exposure, and body mass index controlled, the estimated relative risk of moderate/severe wrinkling for current smokers compared to never smokers was 2.3 (95% confidence interval [CI] = 1.2, 4.2) among men and 3.1 (95% CI = 1.6, 5.9) among women. Pack-years was positively associated with facial wrinkle score in women aged 40 through 69 years and in men aged 40 through 59 years. In both groups, the increased risk of wrinkling was equivalent to about 1.4 years of aging. CONCLUSIONS. Our results support earlier findings that risk of facial wrinkling is greater in cigarette smokers than in never smokers.     

Cigarette smoking and increased risk of mucinous epithelial ovarian cancer

Several studies have reported that cigarette smoking is associated with an increased risk of mucinous ovarian cancer, but other studies have failed to find such a relation. Using data from the Case-Control Surveillance Study, begun in four US cities in 1976, the authors conducted a case-control study (1976-2001) to examine the association between cigarette smoking and the risk of ovarian cancer of different cell types. Among 709 incident cases of epithelial ovarian cancer, 402 were serous, 74 were mucinous, 106 were endometrioid, and 127 were of other cell types. For mucinous ovarian cancer, the odds ratios were 1.5 (95% confidence interval (CI): 0.7, 3.4) among women who smoked less than one pack of cigarettes per day, 1.4 (95% CI: 0.6, 3.5) among women who smoked one pack per day, and 2.9 (95% CI: 1.2, 7.5) among women who smoked more than one pack per day, relative to never smokers. The odds ratios were 2.5 (95% CI: 1.1, 5.4) for ex-smokers and 1.4 (95% CI: 0.7, 2.9) for current smokers. While women with up to 15 pack-years of smoking had an almost 2.5 times' increased risk of mucinous ovarian cancer, such an increased risk was not found among those with more than 15 pack-years of smoking. There was no association between cigarette smoking and epithelial ovarian cancer of other cell types. Despite inconsistencies in the data, these results strengthen the evidence that cigarette smoking may play a role in the development of mucinous ovarian cancer but not ovarian cancer of other cell types.     

Active and passive smoking and depression among Japanese workers

OBJECTIVE: To assess the relation of passive and active smoking to depressive symptoms in 1839 men and 931 women working in a suburb of Tokyo in 2002. METHOD: Self-reported smoking history and exposure to passive smoking (no, occasional, or regular) at work and at home. Depressive symptoms according to the Center for Epidemiologic Studies Depression Scale, with a cut-off point of 16. RESULTS: Compared to never smokers unexposed to passive smoking, never smokers reporting regular and occasional exposure to passive smoking at work had increased depressive symptoms. The adjusted odds ratios (aORs) were 1.92 (95% confidence interval (CI) 1.14, 3.23) for regular exposure and 1.63 (95% CI 1.08, 2.47) for occasional exposure. Current smokers had significantly increased depressive symptoms (aOR ranging from 2.25 to 2.38) but former smokers had only marginal increases of depressive symptoms (aOR ranging from 1.43 to 1.55). Gender did not modify the effects of active/passive smoking on depressive symptoms. CONCLUSION: Passive smoking at work and current smoking appear associated with higher levels of depressive symptoms.     

Risk factors for sick leave due to musculoskeletal disorders among self-employed Dutch farmers: a case-control study

BACKGROUND: In Dutch agriculture, musculoskeletal disorders are a main cause of sick leave. Among self-employed insured farmers, neck, shoulder, upper extremity, and back disorders accounted for 30% of the claims for sick leave of less than 1 year This case-control study set out to identify and quantify risk factors for sick leave due to musculoskeletal disorders among self-employed Dutch farmers. METHODS: Sick leave, claimed at an insurance company from 1998 to 2001 for back (SL-BP, n = 198) or neck/shoulder/upper extremity trouble (SL-EXT, n = 89) was analyzed; the controls did not file any claim in this period (n = 816). RESULTS: Multivariate analysis showed that risk factors for SL-BP were increased age (OR = 1.06 per year, CI = 1.04-1.09), body mass index (BMI) >27 (OR = 1.93, CI = 1.2-3.2), smoking (OR = 1.90, CI = 1.2-2.9), former pain (OR = 3.28, CI = 2.1-5.1), tractor driving >1,000 hr/year (OR = 2.44, CI = 1.0-6.4), and "high work pace and workload" (OR = 1.59, CI = 1.0-2.4). SL-EXT was associated with pig (OR = 3.63, CI = 1.4-9.7), mushroom (OR = 6.14, CI = 1.4-27.2), or dairy/pig farming (OR = 4.56, 1.1-19.5), while age (OR = 1.10, CI = 1.06-1.14), smoking (OR = 1.79, CI = 1.0-3.2), and former pain (OR = 3.37, CI = 1.9-6.1) were also contributing. CONCLUSIONS: Prevention of sick leave of self-employed farmers should focus on life style (obesity, smoking), reducing older farmers' exposure to physical load, exposure to long-term tractor driving. Specific attention should be paid to animal and mushroom farmers.     

Association of active and passive smoking with occupational injury in manual workers: a cross-sectional study of the 2011 Korean working conditions survey

This study was conducted to investigate the relationship of active and passive smoking with occupational injury among manual workers. Data from the 2011 Korean Working Conditions Survey were analyzed for 12,507 manual workers aged ≥15 yr. Overall, 60.4% of men and 5.8% of women were current smokers. The prevalence of injury was higher among never smokers who were exposed to secondhand smoke (SHS) (7.7% in men and 8.1% in women) than current smokers (4.2% in men and 4.1% in women). After controlling for potential confounders, in men, compared to those who never smoked and were not exposed to SHS, people who never smoked and were exposed to SHS (adjusted odds ratio (aOR)=3.7, 2.2–6.4) and current smokers (aOR=2.5, 1.6–3.8) were more likely to experience injury. Among women, the aORs of occupational injury were 8.4 (4.2–16.7) for never smoking women with occasional exposure to SHS and 3.5 (95% CI: 1.4–8.7) for current smokers, in comparison to never smoking women who were never exposed to SHS at work (reference group). The present study suggests that exposure to SHS is a possible risk factor of occupational injury for never smoking men and women.     

Cigarette smoking and the risk of breast cancer

The authors examined the relation between cigarette smoking and breast cancer in the Centers for Disease Control Cancer and Steroid Hormone Study, a multicenter, population-based case-control study. The study compared 4,720 women aged 20-54 years with newly diagnosed breast cancer identified through population-based tumor registries with 4,682 women randomly selected from the same geographic areas. Women who reported ever smoking cigarettes had a risk of breast cancer of 1.2 (95 percent confidence interval 1.1-1.3) compared with never smokers. There was no consistent dose-response pattern with any measure of smoking (pack-years of smoking, average number of cigarettes per day, or total years smoked) and little difference in risk between current and former smokers. There was some variation in risk by age, with slightly higher risk estimates for younger women than for older women. Although current smokers had an earlier natural menopause than did never smokers, the authors found no evidence of a protective effect of cigarette smoking on breast cancer risk. These findings suggest that the risk of breast cancer in women who smoke is the same as, or perhaps slightly higher than, women who have never smoked.     

Smoking habits and type 2 diabetes mellitus in women

The purpose of this case–control study was to evaluate the relationship between smoking and type 2 diabetes mellitus (T2DM) in adult females. A total of 168 women in Kaunas, Lithuania with newly diagnosed T2DM during the year 2001 and 336 controls who were women without diabetes were recruited. Participants were asked about their duration of smoking, the number of cigarettes smoked per day, pack-years, and smoking cessation. Odds ratios (OR), 95 percent confidence intervals (CI) for T2DM were calculated using conditional logistic regression. After adjustment for possible confounders, women with T2DM had a nearly threefold higher odds for smoking 10 or more cigarettes per day compared with controls and using never smokers as the referent category (OR = 2.8; 95 percent CI 1.0–7.7). Women with T2DM had over fourfold odds for having smoked for 40 years or more compared to controls (OR = 4.6; 95 percent CI 1.1–18.6). Compared to controls, women with T2DM had over a sixfold higher odds for stopping smoking for 19 or fewer years with never smokers as the referent category (OR = 6.4; 95 percent CI 1.5–27.3). The findings of our study suggest a possible relationship between smoking and T2DM in women. Also, despite smoking cessation, the association with T2DM remained for a long time.     

Cigarette smoking and completed suicide among middle-aged men: a population-based cohort study in Japan

PURPOSE: To clarify whether cigarette smoking was associated with completed suicide in a cohort of middle-aged Japanese men. METHODS: A total of 45,209 out of 57,714 men, aged 40 to 69 years, in nine public health centers across Japan responded to a self-administered questionnaire that included questions regarding their smoking history. The questionnaire was distributed in 1990 (Cohort I) and in 1993 and 1994 (Cohort II). By the end of 2000, 173 suicides were identified by death certificates. RESULTS: After adjusting for potential confounders, current smokers had a marginally higher risk of suicide than never smokers. Current smokers with more than 60 pack-years of cigarette smoking had a more than two-fold higher risk of suicide than never smokers (pooled multivariate relative risk=2.1; 95% confidence interval, 1.1, 4.0), but a significant dose-response relationship between pack-years of smoking and suicide was not found. The risk of suicide increased significantly with increasing numbers of cigarettes smoked per day (p for trend=0.036). Smoking status, duration of quitting, duration of smoking, and age at the start of smoking were not significantly associated with suicide risk. CONCLUSION: Our results suggest that heavy smoking, particularly a large number of cigarettes per day at baseline was associated with an increased risk of suicide independent of several potential confounders.     

吸烟对慢性阻塞性肺疾病及呼吸道症状的影响

  目的   探讨吸烟对慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)及呼吸道症状的影响。   方法   利用多阶段分层整群随机抽样的方法在安徽5个COPD监测点抽取≥40岁调查对象, 并对其进行问卷调查、身体测量和肺功能检测。利用复杂抽样Logistic回归分析模型分析吸烟对COPD及呼吸道症状的影响。   结果   ≥30包年的吸烟者在总人群中占13.9%(95% CI:10.3%~17.5%, P < 0.001), ≥40年的吸烟者在总人群中占8.5%(95% CI:6.7%~10.3%, P < 0.001)。吸烟者平均吸烟年数为32.4 (95% CI:31.2~33.5)年, 吸烟者日均吸烟量为21.1 (95% CI:19.6~22.7)支/天。调整混杂因素后, COPD和呼吸道症状的患病风险均随吸烟包年和吸烟年数的增加而呈上升趋势(均有P_trend < 0.001)。   结论   吸烟增加COPD及呼吸道症状的患病风险, 吸烟包年和吸烟年数越多, 慢阻肺和呼吸道症状的患病风险越大。     

Cigarette smoking and incidence of multiple sclerosis.

Experimental data suggest that cigarette smoking may play a role in the development of multiple sclerosis (MS), but epidemiologic studies have been small and inconclusive. The authors assessed the association between MS incidence and smoking in two cohort studies of US women, the Nurses' Health Study (121,700 women aged 30-55 years at baseline in 1976) and the Nurses' Health Study II (116,671 women aged 25-42 years at baseline in 1989). Smoking history was assessed at baseline and updated on biennial questionnaires. A total of 315 definite or probable cases of MS were documented. Compared with that for women who never smoked, the relative incidence rate was 1.6 (95% confidence interval: 1.2, 2.1) among current smokers and 1.2 (95% confidence interval: 0.9, 1.6) among past smokers after adjustment for age, latitude, and ancestry. The relative rate increased significantly with cumulative exposure to smoking (p for trend < 0.05), from 1.1 (95% confidence interval: 0.8, 1.6) for 1-9 pack-years to 1.5 (95% confidence interval: 1.2, 2.1) for 10-24 pack-years and 1.7 (95% confidence interval: 1.2, 2.4) for 25 or more pack-years. Similar results were obtained after adjustment for other potential confounding factors. Although these prospective results do not prove a cause-and-effect relation, they suggest that smoking is associated with an increased risk of MS.     

Cigarette smoking and glycaemia: the EPIC-Norfolk Study. European Prospective Investigation into Cancer.

BACKGROUND: Previous prospective studies have suggested that cigarette smoking may be associated with an increased risk of type 2 diabetes, but the possibility of confounding, particularly by dietary factors has not been fully examined. METHODS: Cross-sectional analysis of the association between cigarette smoking and HbA(1C), a marker of long-term glucose homeostasis in 2704 men and 3385 women, aged 45--74 years who were recruited to a population-based study of diet and chronic disease. RESULTS: Twelve per cent of men and 11% of women reported being current smokers. Mean HbA(1C) was lowest in never smokers, intermediate in former smokers and highest in current smokers. There was a dose-response relationship between HbA(1C) levels and number of cigarettes smoked per day and a positive association with total smoking exposure as measured by pack-years. The unadjusted increase in HbA(1C) for 20 pack-years of smoking was 0.12% (95% CI : 0.09--0.16) in men and 0.12% (95% CI : 0.08--0.17) in women. After adjustment for possible confounders including dietary variables, the values were 0.08% (95% CI : 0.04--0.12) and 0.07% (95% CI : 0.02--0.12) for men and women, respectively. Mean HbA(1C) was inversely related to time since quitting smoking in men. CONCLUSIONS: These results add support to the hypothesis that smoking has long-term effects on glucose homeostasis, an association that cannot be explained by confounding by dietary factors as measured in this study.     

Environmental tobacco smoke and the risk of pancreatic cancer: findings from a Canadian population-based case-control study

BACKGROUND: Despite the fact that tobacco is a well-recognized risk factor for pancreatic cancer, no study has yet reported on the association between environmental tobacco smoke (ETS) and this malignancy. We investigated the relationship between pancreatic cancer and childhood and adult exposure to ETS using a case-control study design. METHODS: Our study population consisted of 583 pancreatic cancer cases and 4,813 population-based controls that were identified within 8 Canadian provinces between 1994 and 1997. Mail-out questionnaires were used to collect risk factor information and a lifetime residential and occupational history of exposure to ETS. RESULTS: Among never smokers, those who were exposed to ETS both as a child and as an adult had an odds ratio of 1.21 (95% CI=0.60-2.44) relative to those with no exposure. For active smoking, when the referent group consisted of never smokers who had not been regularly exposed to ETS, the risk increases were more pronounced with an increased number of years of smoking, cigarette pack-years, years since quit smoking, and average number of cigarettes smoked daily. CONCLUSIONS: Overall, our results are suggestive of a weak association between pancreatic cancer and ETS. Perhaps more importantly, they suggest that ETS smoking exposures may confound the risk of pancreatic cancer associated with active smoking measures commonly used in epidemiologic studies.     

Smoking expands expected lifetime with musculoskeletal disease

By indirect estimation of mortality from smoking and life table methods we estimated expected lifetime without musculoskeletal diseases among never smokers, ex-smokers, and smokers. We found that although life expectancy of a heavy smoker is 7 years shorter than that of a never smoker, heavy smokers can expect to live more than 2 years longer with musculoskeletal diseases than never smokers.     

Social class, smoking and the severity of respiratory symptoms in the general population

STUDY OBJECTIVE: The prevalence of respiratory symptoms has been found in some studies to vary with social class. One explanation of this link may be the effect of exposure to cigarette smoke. To investigate this, the relation between social class, smoking and respiratory symptoms was explored in a population based survey. DESIGN: A cross sectional survey using a validated questionnaire. SETTING: Two general practices in Staffordshire, United Kingdom. PATIENTS: A random sample of 4237 patients aged 16 and over from two general practices in Staffordshire were mailed a questionnaire enquiring about respiratory symptoms and their severity. MAIN RESULTS: The severity of respiratory symptoms increased with increasing exposure to cigarette smoke and was greater among manual social classes. Current smokers (odds ratio (OR) = 2.9, 95% confidence limits (CI) 2.3, 3.6), past smokers (OR = 1.5, 95% CI 1.2, 1.8) and passive smokers (OR = 1.4, 95% CI 1.0, 1.8) were more likely to report the more severe respiratory symptoms compared with non-smokers. Responders from social class V (OR = 2.4, 95% CI 1.3, 4. 4) were more likely to report the more severe respiratory symptoms compared with social class I, as were responders from social classes IIIM (OR = 1.3, 95% CI 0.9, 1.9) and IV (OR = 1.4, 95% CI 0.9, 2.1). These effects were independent of each other. CONCLUSIONS: This study has shown that social class is linked to the severity of respiratory symptoms, independently of smoking. Although the need to reduce and quit smoking in manual class households remains a crucial preventive issue, other mechanisms by which social class differences may influence symptom occurrence and severity need to be explored.     

Tobacco smoking in relation to pain in a national general population survey

BACKGROUND: We examined whether smoking status including heavy smoking (20 or more cigarettes per day) is related to the number of pain locations and intensity of pain. METHODS: A probability sample of the German national population aged 18 to 79 including 7124 participants (response proportion: 61.4%) was used. All individuals underwent a health examination between 1997 and 1999. Ordinal logistic regression analyses were performed with number of pain locations and pain intensity as dependent variables which had been assessed by questionnaire. RESULTS: Former and current heavy smokers had higher odds for greater numbers of pain locations and for moderate and intense pain than never smokers after adjustment for analgesic medicament use and behavior-related risk factors. Female former heavy smokers had an adjusted odds ratio (OR) of 1.6 (95% confidence interval, CI, 1.2-2.2) and male former heavy smokers had an adjusted OR of 1.4 (CI 1.1-1.8) for higher numbers of pain locations compared to never smoking women and men respectively (female current smokers: OR 1.4, CI 1.0-1.9; male current smokers: OR 1.3, CI 1.1-1.7). CONCLUSION: The findings suggest that former and current heavy smokers are more likely to report more pain locations and more intense pain than never smokers.     

Risk factors for neck-shoulder and wrist-hand symptoms in a 5-year follow-up study of 3,990 employees in Denmark

OBJECTIVES: A prospective follow-up study of employees in Denmark was analyzed in order to investigate the association between physical and psychosocial exposures and musculoskeletal symptoms in the neck-shoulder and wrist-hand regions. METHODS: Data were derived from a 5-year follow-up questionnaire study of a sample of employees in Denmark, aged between 18 and 59 years. Occupational and individual background factors were assessed in 1990, and the associations with symptoms in 1995 were analyzed using logistic regression. The analysis was restricted to comprise employees free of symptoms in 1990. The neck-shoulder and wrist-hand analyses included 1,895 and 3,179 employees, respectively. RESULTS: Among men, neck-shoulder symptoms were predicted by twisting or bending (odds ratio (OR) 1.5, 95% confidence interval (CI) 1.01-2.26) and social support at work (OR 1.8, CI 1.24-2.50 for low versus rather high social support, OR 1.4, CI 1.00-2.09 for high versus rather high social support). Furthermore, an interacting effect of heavy lifting and sedentary work was indicated. Symptoms in the wrist-hand region were predicted by stress symptoms (OR 1.7, CI 1.12-2.71) and twisting or bending (OR 1.7, CI 1.18-2.57). For women, smoking habits predicted neck-shoulder symptoms (OR 1.8, CI 1.14-2.82, former versus never smokers). Symptoms in the wrist-hand region were predicted by stress symptoms (OR 1.7, CI 1.16-2.41) and twisting or bending (OR 1.9, CI 1.34-2.80). CONCLUSION: The results confirm that physical exposures at work influence the development of musculoskeletal symptoms in the neck-shoulder and wrist-hand regions. However, the results also suggest that a psychosocial exposure (social support) and perceived stress symptoms influence musculoskeletal symptoms.     

Six year follow up of lung function in men occupationally exposed to formaldehyde

The long term effects of formaldehyde on the respiratory tract have been investigated in a group of 164 workers exposed daily to the chemical during the production of urea formaldehyde resin, together with 129 workers not exposed to free formaldehyde. Exposure was classified as high (corresponding to an eight hour time weighted exposure of more than 2.0 ppm), medium (0.6 to 2.0 ppm), or low (0.1 to 0.5 ppm). Twenty five per cent of workers had had high exposure at some time and 17% moderate exposure. Both the exposed and unexposed groups had an annual assessment that included lung function. The proportion with self reported respiratory symptoms was similar in the two groups, 12% and 16% reporting breathlessness on hurrying and 26% and 20% wheezing. The initial forced expiratory volume in one second (FEV1) was within 0.5 l (approximately one standard deviation (SD)) of the predicted value (by age and height) in 65% of the exposed and 59% of unexposed workers and more than 0.5 l below the predicted value in 9% of exposed and 11% of unexposed workers. The mean decline in FEV1 was 42 ml a year (SD 45) in the exposed group and 41 ml a year in the unexposed group (SD 40 ml a year). The rate of decline showed the expected association with smoking in the unexposed group, but in the exposed group the mean rate of decline in the never smokers was similar to that in current smokers. There were, however, relatively few never smokers and considerable variation in the rates of decline. In the exposed group no association was found between the rate of decline and indices of exposure to formaldehyde. Thus there is no evidence from this study of an excess of respiratory symptoms or decline in lung function in the workers exposed to formaldehyde. The similar rate of decline of FEV1 however in never smokers and smokers of the exposed group is consistent with findings of other studies for workers exposed to formaldehyde and to toluene di-isocyanate.     

Six year follow up of lung function in men occupationally exposed to formaldehyde.

The long term effects of formaldehyde on the respiratory tract have been investigated in a group of 164 workers exposed daily to the chemical during the production of urea formaldehyde resin, together with 129 workers not exposed to free formaldehyde. Exposure was classified as high (corresponding to an eight hour time weighted exposure of more than 2.0 ppm), medium (0.6 to 2.0 ppm), or low (0.1 to 0.5 ppm). Twenty five per cent of workers had had high exposure at some time and 17% moderate exposure. Both the exposed and unexposed groups had an annual assessment that included lung function. The proportion with self reported respiratory symptoms was similar in the two groups, 12% and 16% reporting breathlessness on hurrying and 26% and 20% wheezing. The initial forced expiratory volume in one second (FEV1) was within 0.5 l (approximately one standard deviation (SD)) of the predicted value (by age and height) in 65% of the exposed and 59% of unexposed workers and more than 0.5 l below the predicted value in 9% of exposed and 11% of unexposed workers. The mean decline in FEV1 was 42 ml a year (SD 45) in the exposed group and 41 ml a year in the unexposed group (SD 40 ml a year). The rate of decline showed the expected association with smoking in the unexposed group, but in the exposed group the mean rate of decline in the never smokers was similar to that in current smokers. There were, however, relatively few never smokers and considerable variation in the rates of decline. In the exposed group no association was found between the rate of decline and indices of exposure to formaldehyde. Thus there is no evidence from this study of an excess of respiratory symptoms or decline in lung function in the workers exposed to formaldehyde. The similar rate of decline of FEV1 however in never smokers and smokers of the exposed group is consistent with findings of other studies for workers exposed to formaldehyde and to toluene di-isocyanate.     

Smoking expands expected lifetime with musculoskeletal disease regardless of educational level

Lifetime with musculoskeletal disease were estimated for never smokers and smokers at three educational levels. Expected lifetime with musculoskeletal disease was 7.4 and 10.6 years for 30-year-old men and women, respectively. Regardless of educational level smokers could expect more years with the diseases than never smokers. Thus, the impact of smoking on the burden of musculoskeletal diseases is not confounded by educational level.     

Relation of smoking and alcohol consumption to incident Alzheimer's disease.

The authors examined the effects of smoking and alcohol use in a prospective community-based study of incident Alzheimer's disease. Two in-home interviews of the total elderly population of East Boston, Massachusetts, conducted in 1982 and 1985 were used to sample individuals for clinical evaluation for Alzheimer's disease. A total of 513 persons underwent detailed clinical evaluation including neurologic, neuropsychologic, and psychiatric evaluation to diagnose Alzheimer's disease. In weighted logistic regression controlled for age, sex, and education, the estimated odds ratio of Alzheimer's disease was 0.7 (95% confidence interval 0.3-1.4) for ever smokers compared with never smokers. For 40 pack-years of smoking, the odds ratio of Alzheimer's disease was 0.8 (95% confidence interval 0.6-1.1). Consumption of 1 oz (30 ml) of alcohol per day was associated with an odds ratio of 1.1 (95% confidence interval 0.8-1.5). These results suggest that recent mild-to-moderate consumption of alcohol is not substantially related to incidence of Alzheimer's disease and that smoking does not increase risk of the disease.