Body mass decrease after initial gain following smoking cessation

BACKGROUND: Although smoking cessation is strongly associated with subsequent weight gain, it is not clear whether the initial gain in weight after smoking cessation remains over time. METHOD: Cross-sectional analyses were made, using data from periodic health examinations for workers, on the relationship between body mass index (BMI) and the length of smoking cessation. In addition, linear regression coefficients of BMI on the length of cessation were estimated according to alcohol intake and sport activity, to examine the modifying effect of these factors on the weight of former smokers. RESULTS: Means of BMI were 23.1 kg/m2, 23.3 kg/m2, 23.6 kg/m2 for light/medium smokers, heavy smokers and never smokers, respectively. Among former smokers who had smoked > or = 25 cigarettes a day, odds ratio (OR) of BMI >25 kg/m2 were 1.88 (95% confidence interval [CI] : 1.05-3.35), 1.32 (95% CI : 0.74-2.34), 0.66 (95% CI: 0.33-1.31) for those with 2-4 years, 5-7 years, and 8-10 years of smoking cessation, respectively. The corresponding OR among those who previously consumed <25 cigarettes a day were 1.06 (95% CI: 0.58-1.94), 1.00 (95% CI: 0.58-1.71), and 1.49 (95% CI: 0.95-2.32). CONCLUSIONS: The results suggest that although heavy smokers may experience large weight gain and weigh more than never smokers in the few years after smoking cessation, they thereafter lose weight to the never smoker level, while light and moderate smokers gain weight up to the never smoker level without any excess after smoking cessation.     

Active and passive smoking and risk of breast cancer by age 50 years among German women

Recent studies suggest that both active and passive smokers have an increased risk of breast cancer compared with women who have never been either actively or passively exposed. Data on lifetime active and passive smoking were collected in 1999-2000 from 468 predominantly premenopausal breast cancer patients diagnosed by age 50 years and 1,093 controls who had previously participated in a German case-control study conducted in 1992-1995. Compared with never active/passive smokers, former smokers and current smokers had odds ratios of 1.2 (95% confidence interval (CI): 0.8, 1.7) and 1.5 (95% CI: 1.0, 2.2), respectively, and ever active smokers had an odds ratio of 1.3 (95% CI: 0.9, 1.9). The risk increased with duration of smoking and decreased after cessation of smoking. Among never active smokers, ever passive smoking was associated with an odds ratio of 1.6 (95% CI: 1.1, 2.4). Exposure to environmental tobacco smoke during childhood or before the first pregnancy did not appear to increase breast cancer risk. At greatest risk were women who had a high level of exposure to both passive and active smoking (odds ratio = 1.8, 95% CI: 1.2, 2.7). This study strengthens the hypothesis of a causal relation between active and passive smoke exposures and breast cancer risk.     

Migration and smoking: an epidemiological study of Finnish twins in Sweden

BACKGROUND: Male migrants from Finland to Sweden have been found to have a reduced risk of coronary heart disease after several years in Sweden. Changes in smoking habits may contribute to this reduced risk. AIMS: A study was undertaken to compare smoking habits in Finnish migrants to Sweden and subjects always living in Finland and to analyse whether the migration may have influenced smoking. METHODS: The study population consisted of same-sex twin pairs born in Finland younger than 76 years with at least one twin that had migrated to Sweden (n = 1,083 pairs). Smoking habits obtained by mailed questionnaire were compared in migration-discordant twin pairs to take into account early childhood and genetic factors. RESULTS: Immigrants and returnees with a history of smoking had predominantly started to smoke before the migration. Among women, immigrants to Sweden smoked more than never migrants in Finland, odds ratio (OR) 2.1 for current smokers (95% confidence interval CI 1.4-3.3) but this difference was already present before migration. In men there were essentially no differences in smoking prevalence between immigrants and never migrants but heavy smoking was less common among immigrants than among never migrant smokers, OR 0.5 (95% CI 0.2-0.9) and migration was associated with a greater propensity to cease smoking. CONCLUSIONS: Migration from Finland to Sweden does not seem to have had a strong influence on smoking among migrants. A favourable trend in smoking habits after migration may in part have contributed to reduced mortality and incidence of coronary heart disease in male Finnish migrants after several years in Sweden.     

Cigarette smoking, menstrual symptoms and miscarriage among young women

OBJECTIVE: To examine associations between cigarette smoking and menstrual symptoms and miscarriage among young women. METHOD: The study sample consists of 14,779 women aged 18-23 years who participated in the mailed baseline survey for the Australian Longitudinal Study on Women's Health, conducted in 1996. The main outcome measures are self reported menstrual symptoms and miscarriages. RESULTS: Current smokers and ex-smokers had an increased risk of menstrual symptoms and miscarriages compared with women who had never smoked, with the highest risk occurring in heavy smokers (adjusted odds ratios for those smoking > or = 20 cigarettes per day: premenstrual tension 1.5 (95% confidence interval 1.3 to 1.7), irregular periods 1.5 (1.3 to 1.8), heavy periods 1.6 (1.4 to 1.9), severe period pain 1.5 (1.4 to 1.7), one or more miscarriages 2.0 (1.5 to 2.8). The odds ratios generally increased with numbers of cigarettes smoked and a younger age of starting to smoke. CONCLUSION: This study suggests that young women who smoke are at higher risk of a range of menstrual problems and miscarriage than those who have never smoked. The immediacy of this risk (in contrast to the longer term risks of chronic disease) can be used to improve the relevance of anti-smoking campaigns targeted to young women.     

Snuff use and smoking in U.S. men: implications for harm reduction

BACKGROUND: Encouraging smokers to switch to snuff may have unintended public health implications. This study examined the associations between snuff use and smoking in a representative sample of U.S. men. METHODS: Subjects were males aged >or=18 years in the National Health Interview Survey (N=13,865). The data analysis was conducted between August 2001 and April 2002. Multiple logistic regression modeling was used to examine the association between using snuff and quitting smoking. RESULTS: In 1998, 26.4% of U.S. men smoked, 3.6% used snuff, and 1.1% used both products. Adjusting for age and race/ethnicity, current smoking was most prevalent among males who used snuff on some days (38.9%) and lowest among those who used snuff every day (19.2%). Daily snuff users were significantly more likely than never-users to have quit smoking in the preceding 12 months (odds ratio [OR]=4.23; 95% confidence interval [CI]=2.16-8.28). However, U.S. men were more likely to be former snuff users who currently smoked (2.5%) than to be former smokers who currently used snuff (1.0%). Occasional snuff users (some day users) were more likely than never users to have tried to quit smoking in the preceding year (OR=1.69; 95% CI=1.04-2.76) but tended to be less likely to succeed (OR=0.50; 95% CI=0.19-1.33). CONCLUSIONS: Some men may use snuff to quit smoking, but U.S. men more commonly switch from snuff use to smoking. Some smokers may use snuff to supplement their nicotine intake, and smokers who also use snuff are more likely than nonusers to try to quit smoking but tend to have less success.     

Depressive symptoms and cigarette smoking among Latinos in San Francisco.

We administered the Center for Epidemiological Studies Depression (CES-D) Scale to 547 San Francisco Latinos as part of a random digit dialing telephone survey to evaluate smoking behavior. Both men and women current smokers had the highest mean CES-D levels (9.7 and 14.3, respectively). Logistic regression analysis adjusting for gender, acculturation, education, age, and employment showed that current smokers had an odds ratio of 1.7 (95% CI = 1.3, 2.2) for significant depressive symptoms compared to former smokers (OR = 1.1;95% CI = .8, 1.6) and never smokers (OR = 1).     

Gender Differences in Smoking and Self Reported Indicators of Health

HEALTH ISSUE: Smoking among Canadian women is a serious public health issue. Using the 1998-99 National Population Health Survey, this study examined underlying factors contributing to differences in prevalence of smoking among subgroups of women and men, and its effects on self-reported indicators of health. KEY FINDINGS: In Canada, 26.4% of women and 29.2% of men were classified as current smokers. Higher levels of education and income were associated with decreased odds of current smoking. Adjusting for all other factors, being an ethnic minority decreased the odds of current smoking for both men and women (OR:0.35, 99%CI:0.23-0.54; OR:0.13, 99%CI: 0.09-0.20 respectively). Single mothers had the highest odds of smoking (OR: 2.12, 99%CI: 1.28-3.51) when compared to married mothers with children under 25 years of age. Current women smokers and current and former men smokers were less likely to report very good or excellent health compared with never smokers (OR: 0.83, 99%CI: 0.70-0.98; OR: 0.49, 99%CI: 0.41-0.60; OR: 0.75, 99%CI: 0.63-0.90 respectively). Women who were current smokers had increased odds of needing health care and not receiving it (OR: 1.50, 99%CI: 1.10-2.05). DATA GAPS AND RECOMMENDATIONS: Key issues for Canadian women include an increased prevalence of smoking among young girls and the strong association between smoking and social and economic disadvantage. Tobacco control policies and programs must target high-risk groups more effectively. Of particular importance is the development of programs and policies that do not serve to reinforce existing inequities, but rather, contribute to their amelioration.     

Relationships between self-reported smoking, household environmental tobacco smoke exposure and depressive symptoms in a pregnant minority population

This study sought to examine relationships between depressive symptoms and prenatal smoking and/or household environmental tobacco smoke exposure (HH-ETSE) among urban minority women. We analyzed private, audio computer-assisted self interview data from a clinic-based sample of 929 minority pregnant women in Washington, DC. Depressive symptoms were assessed via the Beck Depression Inventory Fast Screen. HH-ETSE, current smoking, and former smoking were assessed via self-report. Depression levels and demographic characteristics were compared: (1) among nonsmokers, for those reporting HH-ETSE versus no HH-ETSE; and (2) among smokers, for those reporting current smoking (in last 7 days) versus former smokers. Measures associated with HH-ETSE/current smoking in bivariate analysis at P < 0.20 were included in adjusted logistic regression models. HH-ETSE, as a possible indicator of a social smoking network, was assessed as a mediator for the relationship between depression and current smoking. Results: Non-smokers reporting moderate-to-severe depressive symptoms showed significantly higher adjusted odds of prenatal HH-ETSE (AOR 2.5, 95% CI [1.2, 5.2]). Smokers reporting moderate-to-severe or mild depressive symptoms showed significantly higher adjusted odds of current smoking (AOR 1.9, 95% CI [1.1, 3.5] and AOR 1.8, 95% CI [1.1, 3.1], respectively). Among smokers, HH-ETSE was a significant mediator for the association between moderate-to-severe symptoms and current smoking. In conclusion, health care providers should be aware that depressed urban minority women are at risk of continued smoking/HH-ETSE during pregnancy. Interventions designed to encourage behavior change should include screening for depression, and build skills so that women are better able to address the social environment.     

Smoking and musculoskeletal disorders in the metal industry: a prospective study

OBJECTIVES: To obtain longitudinal information of the relation between smoking and musculoskeletal disorders in an industrial setting. METHODS: The associations of lifetime tobacco exposure (pack-years), current smoking status, and stopping smoking with back and limb disorders were studied in a cohort of white collar and blue collar employees in a metal industry. Measurements were made three times at 5 year intervals. Two thirds of an initial sample of 902 took part in both re-examinations. Musculoskeletal morbidity was measured as the abundance of symptoms during the past year and as clinical findings assessed by a physiotherapist (upper decile score/score difference = index category). Logistic regression and a generalised estimating equation were used, allowing for sociodemographic variables, physical workload, body mass index, exercise activity, and mental distress. RESULTS: By comparison with never smokers, exposure of 10-< 20 pack- years, the odds ratio (OR) (95% confidence interval (95% CI) of the 10 year change in neck-shoulder symptoms was 3.1 (1.4 to 6.8), in low back symptoms 2.4 (1.1 to 5.1), in upper limb symptoms 1.9 (NS), and in lower limb symptoms 3.4 (1.5 to 7.8). The highest exposure category of > or = 20 pack-years was associated with the change in upper limb findings 2.9 (1.4 to 6.2) and lower limb findings 2.9 (1.2 to 7.2). Those who continued to smoke through the follow up period had a higher increase in clinical findings 2.5 (1.1 to 5.9) than never smokers. There was a dose-response in the association of smoking intensity with future musculoskeletal symptoms. Also, those who stopped smoking during the follow up had a higher increase in symptoms 4.4 (2.0 to 9.9) and findings 3.5 (1.4 to 8.8) than never smokers. CONCLUSION: Smoking seems to predict the development in the occurrence of musculoskeletal symptoms and signs. Stopping smoking is associated with high morbidity.

 

     

Active Smoking,Passive Smoking,and Risk of Nonalcoholic Fatty Liver Disease (NAFLD): A Population-Based Study in China

Background

The effect of active smoking on development of nonalcoholic fatty liver disease (NAFLD) is controversial, and there are limited clinical data on the relationship between passive smoking and NAFLD. We investigated whether active and passive smoking are associated with NAFLD.

Methods

A total of 8580 subjects (2691 men) aged 40 years or older participated in a community-based survey in Shanghai, China. Information on active and passive smoking was collected using a validated questionnaire. NAFLD was diagnosed by abdominal B-mode ultrasound testing and serum liver enzymes.

Results

NAFLD prevalence was 29.4% in never smokers, 34.2% in former smokers, 27.8% in light smokers (<20 cigarettes/day), 30.8% in moderate smokers (20–39 cigarettes/day), and 43.5% in heavy smokers (≥40 cigarettes/day). Fully adjusted logistic regression analyses revealed that, as compared with never smoking, former and heavy smoking were associated with increased risk of prevalent NAFLD, with odds ratios of 1.45 (95% CI 1.05–2.00) and 2.29 (95% CI 1.30–4.03), respectively. Active smoking and body mass index (BMI) had a synergistic effect on the risk of prevalent NAFLD; the combination of these risk factors was associated with the highest observed odds ratio for NAFLD: 8.58. In never-smoking women, passive smoking during both childhood and adulthood was associated with a 25% increase in the risk of prevalent NAFLD (OR = 1.25, 95% CI 1.05–1.50) as compared with no passive smoking.

Conclusions

Passive smoking and heavy active smoking are associated with prevalent NAFLD in middle-aged and elderly Chinese. Active smoking and BMI have a synergistic effect on prevalent NAFLD.Key words: active tobacco smoking, passive tobacco smoking, fatty liver     

An examination of the relationship between municipal smoke-free bylaw strength and the odds of being a former smoker

OBJECTIVE: The purpose of this study was to examine the relationship between municipal no-smoking bylaw strength and the odds of being a former smoker. METHODS: Data from Statistics Canada's Canadian Community Health Survey (Cycle 1.1, 2001) and a validated bylaw scoring scheme (2001) were linked and analyzed to determine whether the odds of being a former smoker were related to the strength of no-smoking bylaws in municipalities that had been matched for potentially confounding factors. The sample consisted of ever smokers (current and former smokers) from Ontario municipalities that did not have a no-smoking bylaw, or had a fully implemented no-smoking bylaw before September 2000. Data were analyzed using a Mantel-Haenszel Chi-square test and a logistic regression. RESULTS: The results from the Mantel-Haenszel (OR = 0.94, 95% CI 0.80-1.12) and logistic regression analyses (OR = 0.95, 95% CI 0.82-1.11) did not find support for the hypothesis that living in a municipality with a strong no-smoking bylaw would increase the odds of being a former smoker. DISCUSSION: Findings were inconsistent with previous studies that have found no-smoking restrictions in homes, workplaces and public places increase the odds that smokers attempt and succeed in quitting smoking. However, results from this study must be interpreted with caution because of the cross-sectional design and limited control of potentially important covariates.     

Associations of maternal prenatal smoking with child adiposity and blood pressure

OBJECTIVE: To examine the extent to which maternal prenatal smoking is associated with adiposity, central adiposity, and blood pressure in 3-year-old children. RESEARCH METHODS AND PROCEDURES: We studied 746 mother-child pairs in Project Viva, a prospective cohort study, and categorized mothers as never, early pregnancy, or former smokers. Main outcome measures were overweight (BMI for age and sex > 85th percentile), BMI z-score, sum of subscapular (SS) and triceps (TR) skinfolds, SS:TR skinfold ratio, and systolic blood pressure (SBP). RESULTS: One hundred sixty-one (22%) mothers quit smoking before pregnancy, 71 (10%) smoked in early pregnancy, and 514 (69%) never smoked. At age 3 years, 204 (27%) children were overweight. On multivariable analysis, compared with children of never smokers, children of early pregnancy smokers had an elevated risk for overweight [odds ratio (OR), 2.2; 95% confidence interval (CI), 1.2, 3.9] and higher BMI z-score (0.30 units; 95% CI, 0.05, 0.55), SS + TR (2.0 mm; 95% CI, 0.9, 3.0), and SBP (2.4 mm Hg; 95% CI, -0.1, 4.9). Children of former smokers were not more overweight (BMI z-score, 0.02 units; 95% CI, -0.15, 0.19) but had higher SBP (1.5 mm Hg; 95% CI, -0.1, 3.2). We saw no relationship of smoking with central adiposity (SS:TR). DISCUSSION: Former and early pregnancy smokers had children with somewhat higher SBP, but only early pregnancy smokers had children who were more overweight. Mechanisms linking smoking with child adiposity and blood pressure may differ. A long-term impact of maternal smoking on offspring cardiovascular risk provides further reason to reduce smoking in women.     

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.     

吸烟对不同收入人群慢性病患病的影响

目的探讨吸烟对不同经济状况人群的健康影响。方法采用多阶段分层整群随机抽样的方法，在全国共抽取95个县、950个村(居委会)，每个样本村(居委会)随机抽取60户家庭，全国共抽取55200户家庭中15～65岁男性5．93万人。结果研究发现在控制年龄、经济状况、文化程度、就业状况、工作岗位的情况下，不论农村、城镇，与从不吸烟的人相比，有吸烟史的人群慢性病患病率均高(农村OR=1．185，95％CI：1．121～1．253；城镇OR=1．083，95％CI：1．010～1．161)；吸烟对农村男性患慢性病的影响(戒烟OR=2．764，95％CI：2．471～3．092)要大于城镇的相应人群(戒烟OR=2．112，95％CI：1．844～2．419)；另外发现吸烟对低收入人口患慢性病的影响(城镇OR=2．076，95％CI：1．551～2．780；农村OR=2．903，95％CI：2．248～3．749)大于对高收入人口的影响(城镇OR=1．785，95％CI：1．285～2．479；农村OR=2．466，95％CI：1．941～3．134)。结论吸烟对收入低下的人群健康损害更大，应该引起重视。     

Role of tobacco use in the etiology of acoustic neuroma

Two previous studies suggest that cigarette smoking reduces acoustic neuroma risk; however, an association between use of snuff tobacco and acoustic neuroma has not been investigated previously. The authors conducted a case-control study in Sweden from 2002 to 2007, in which 451 cases and 710 population-based controls completed questionnaires. Cases and controls were matched on gender, region, and age within 5 years. The authors estimated odds ratios using conditional logistic regression analyses, adjusted for education and tobacco use (snuff use in the smoking analysis and smoking in the snuff analysis). The risk of acoustic neuroma was greatly reduced in male current smokers (odds ratio (OR) = 0.41, 95% confidence interval (CI): 0.23, 0.74) and moderately reduced in female current smokers (OR = 0.70, 95% CI: 0.40, 1.23). In contrast, current snuff use among males was not associated with risk of acoustic neuroma (OR = 0.94, 95% CI: 0.57, 1.55). The authors' findings are consistent with previous reports of lower acoustic neuroma risk among current cigarette smokers than among never smokers. The absence of an association between snuff use and acoustic neuroma suggests that some constituent of tobacco smoke other than nicotine may confer protection against acoustic neuroma.     

Tobacco smoking among Portuguese high-school students.

The aim of this study was to evaluate the prevalence, behavioural patterns, and determinants of smoking among a large sample of high-school students from Porto, the second largest city in Portugal, information on sociodemographic characteristics and personal history of tobacco, alcohol, coffee, and illicit drug use was obtained from 2974 students, aged 12-19 years (48.7% female, 51.3% male), using an anonymous self-administered questionnaire. Crude and adjusted odds ratios (OR) were calculated by logistic regression analysis to estimate the association between smoking and the characteristics evaluated. Overall, 35.8% students had never smoked, 39.4% had tried it ("experimental" smokers) but were not smokers, 3.3% were former smokers, 6.6% occasional smokers, and 14.9% regular smokers. The mean age for starting smoking was 13.4 +/- 2.1 years for males and 13.4 +/- 1.6 years for females. The prevalence of current smoking was higher among males than females, but the difference was not significant. Male students were significantly more likely to smoke more cigarettes per day than were females. The prevalence of smoking was significantly associated with the following variables: being aged > 12 years; having parents who had attended school for < 4 years; having a mother (OR = 1.88), siblings (OR = 1.96) or friends (OR = 1.75) who smoked; low academic performance (OR = 1.74 for one or two failures and OR = 2.27 for more than two failures at school); and consumption of coffee (OR = 2.90), alcohol (OR = 3.53), or illicit drugs (OR = 6.69). The prevalence of smoking among adolescents increased with age. There is therefore a need for school-based tobacco prevention programmes which also deal with family influences on smoking.     

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.     

Maternal smoking during pregnancy and the risk of congenital urinary tract anomalies.

To study maternal smoking during pregnancy and the risk of congenital urinary tract anomalies, we interviewed mothers of 118 affected infants born to residents of western Washington State during 1990 and 1991 and mothers of 369 control infants randomly selected from those without birth defects delivered during those years in five hospitals in King County, Washington. Maternal smoking was associated with an increased risk of congenital urinary tract anomalies in offspring (adjusted odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.2, 4.5). This risk was higher among light smokers (1-1000 cigarettes during the pregnancy) (OR = 3.7; 95% CI = 1.7, 8.6) than among heavy smokers (OR = 1.4; 95% CI = 0.6, 3.3). Our results corroborate previous findings and support the hypothesis of a causal relation.     

Smoking and perceived health in Hong Kong Chinese

This population-based cross-sectional study examined the associations between smoking and perceived health in Hong Kong. 6117 healthy Chinese (3053 men, 3064 women), aged 25-74 years, were randomly selected for telephone interviews in Hong Kong in 1994-96. Adjusted odds ratios (ORs) of having poor or very poor perceived health (against good or very good) were calculated. In men, the ORs (and 95 percent confidence intervals) for current smokers in young (25-39) and middle age (40-59) were close to unity, but that of 1.97 (1.01, 3.85) in old age (60-74) was significantly raised. The adjusted ORs for male quitters were 1.98 (0.43, 9.14), 1.70 (0.75, 3.81) and 2.59 (1.23, 3.33) for young, middle and old age, respectively. Compared with current smokers, the adjusted ORs for quitters was 2.30 (1.07, 4.92) for those who had quit for less than 5 years, 2.02 (0.80, 5.11) for 5-9 years and 1.14 (0.47, 2.75) for 10 years or more. Among former smokers, each year of quitting was associated with 7 percent reduction in reporting poor or very poor perceived health with OR of 0.93 (0.85, 1.01). In women, the ORs were 1.95 (1.15, 3.28) for current and 1.54 (0.60, 3.94) for former smokers. In both genders combined, the overall ORs were 1.41 (1.04, 1.92) for current and 1.94 (1.27, 2.97) for former smokers. In conclusion, former smokers apparently had the worst perceived health but long-term quitting was beneficial. Overall, current smokers had worse perceived health than never smokers, but in men the excess risk was mainly observed in old age. The perceived health of smokers may have implications for the approaches used in smoking cessation.     

Apolipoprotein E gene associations in age-related macular degeneration: the Melbourne Collaborative Cohort Study

The apolipoprotein E gene (APOE) has been found to be associated with age-related macular degeneration (AMD). Reported associations have been questioned, as they are opposite those for Alzheimer's disease and cardiovascular disease. The authors examined associations between APOE genotype and AMD using a case-control study (2,287 cases and 2,287 controls individually matched on age, sex, and country of origin) nested within Melbourne Collaborative Cohort Study participants aged 48-86 years at AMD detection. The odds ratio for early AMD among participants with ε2-containing genotypes (ε2ε2/ε2ε3/ε2ε4) was 1.32 (95% confidence interval (CI): 1.11, 1.58; P = 0.002) versus persons with genotype ε3ε3. Associations with early AMD varied by smoking status; ε2-containing genotypes were positively associated with early AMD for never and previous smokers (never smokers: odds ratio (OR) = 1.40, 95% CI: 1.12, 1.76 (P = 0.003); previous smokers: OR = 1.39, 95% CI: 1.00, 1.93 (P = 0.05)) but not for current smokers (OR = 0.66, 95% CI: 0.34, 1.30 (P = 0.2; interaction P = 0.05). The ε4-containing genotype group (ε3ε4/ε4ε4) had an inverse association with early AMD among current smokers only (OR = 0.41, 95% CI: 0.22, 0.77 (P = 0.005)). These results highlight the importance of stratifying by smoking status in elderly populations. Smokers who survive to old age may be more likely to possess unknown genotypes which modify exposure-disease associations.