吸烟与肝癌关系的病例对照研究

[目的 ]评估吸烟对肝癌发生、发展的影响 .[方法 ]在中国 2 4个城市和 74个农村地区 ,随机选择了 196 13名死于肝癌的吸烟者和 770 6名死于肝硬化的吸烟者进行回顾性调查研究 .[结果 ]吸烟可以导致肝癌的超额死亡 ,在 35岁以上的男性吸烟者中 ,肝癌的超额死亡率为 36 % ,吸烟者和非吸烟者导致肝癌的相对危险度为 1 36 ,95 %可信区间为 1 2 9～ 1 4 3,女性吸烟者和非吸烟者的相对危险度为1 2 7,95 %可信区间为 1 16～ 1 36 .每日吸烟量同肝癌的死亡也呈显著的正向关系 .[结论 ]吸烟可能增加患肝癌的风险     

Smoking prevalence and associated risk factors in Canadian adults. Canadian Heart Health Surveys Research Group.

OBJECTIVE: To describe the prevalence and patterns of smoking among Canadian adults, the relation of smoking to other cardiovascular disease risk factors and the awareness of the causes of heart disease. DESIGN: Population-based cross-sectional surveys. SETTING: Nine Canadian provinces, from 1986 to 1990. PARTICIPANTS: A probability sample of 26,293 men and women aged 18 to 74 was selected from the health insurance registries in each province. Of these, 20,585 completed a questionnaire on smoking habits during a home interview. MAIN RESULTS: Approximately 29% of the Canadian population 18 years of age and over were regular cigarette smokers, and over 13% of regular smokers smoked more than 25 cigarettes per day. The proportion of women who had never smoked was higher (37%) than men (24%), except for young women aged 18 to 24. For all participants, there was a lower prevalence of high blood pressure and overweight among smokers than non-smokers. The prevalence of sedentary lifestyle, diabetes and elevated blood cholesterol was positively associated with smoking. The proportion of subjects who identified smoking as a cause of heart disease was higher among smokers, and over 90% believe that heart disease is preventable. CONCLUSION: Because smoking is positively associated with other cardiovascular risk factors, multifactorial and comprehensive approaches are needed in the implementation of cardiovascular disease prevention programs. Knowledge regarding the heart health hazards of smoking is high even among smokers. Motivational approaches that go beyond health risk messages are needed in cessation programs.     

Smoking and death rates: report on forty-four months of follow-up of 187,783 men. 2. Death rates by cause

Information was gathered on the smoking habits of 187,783 white men between the ages of 50 and 69 between January 1 and May 31, 1952. The men were subsequently traced through October 31, 1955. 11,870 men died during this period. The total experience covered 667,753 man years. For microscopically proved cases of cancer and for the total cases reported as cancer it was found that the death rates were higher among regular cigarette smokers than among men who never smoked, that the mortality ratio increased with the number of cigarettes smoked each day, and that the death rates were higher among pipe and cigar smokers than among men who never smoked. 7316 deaths occurred among regular cigarette smokers; this was an excess of 2665 over the 4651 deaths that would have occurred had the age-specific death rates for smokers been equal to that for nonsmokers. Coronary disease accounted for 52.1% of the excess; lung cancer accounted for 13.5% of the excess; and cancer of other sites accounted for 13.5% of the excess. An extremely high association between cigarette smoking and death rates for men with lung cancer was found in both rural areas and large cities. Only 338 deaths were ascribed to pulmonary diseases other than lung cancer. Only 1120 (9.4%) of the 11,870 deaths were attributed to diseases other than cancer, cardiac, circulatory, and pulmonary diseases and accidents, violence, and suicide. Only 3 of the specific disease entities - gastric and duodenal ulcers and cirrhosis of the liver - showed a statistically significant degree of association with smoking habits. The most important finding of this study was the high degree of association between cigarette smoking and the total death rate.     

Respiratory effects of non-tobacco cigarettes

Data from the Tucson epidemiological study of airways obstructive disease on smoking of non-tobacco cigarettes such as marijuana were analysed to determine the effect of such smoking on respiratory symptoms and pulmonary function. Among adults aged under 40, 14% had smoked non-tobacco cigarettes at some time and 9% were current users. The prevalence of respiratory symptoms was increased in smokers of non-tobacco cigarettes. After tobacco smoking had been controlled for men who smoked non-tobacco cigarettes showed significant decreases in expiratory flow rates at low lung volumes and in the ratio of the forced expiratory volume in one second to the vital capacity. This effect on pulmonary function in male non-tobacco cigarette smokers was greater than the effect of tobacco cigarette smoking. These data suggest that non-tobacco cigarette smoking may be an important risk factor in young adults with respiratory symptoms or evidence of airways obstruction.     

Inhaling and lung cancer: an anomaly explained

An objective index of inhaling cigarette smoke based on carboxyhaemoglobin concentrations and the carbon monoxide yields of cigarettes was used to investigate possible systematic differences in the extent of inhaling among light and heavy smokers when classified according to their self described inhaling habits. A total of 2108 men who smoked cigarettes were studied. Heavy smokers (20 or more cigarettes a day) had a higher average inhaling index than light smokers (fewer than 20 cigarettes a day) both among those who said that they inhaled and among those who said that they did not. This observation, together with indirect evidence that heavy smokers who inhale deeply may to some extent avoid depositing smoke condensate on their main bronchial epithelium, explains a hitherto unresolved anomaly--namely, that the risk of lung cancer is less among heavy cigarette smokers who say that they inhale than it is among those who say that they do not inhale.     

Trends in tar, nicotine, and carbon monoxide yields of UK cigarettes manufactured since 1934

The tar, nicotine, and carbon monoxide yields of cigarettes manufactured in the United Kingdom between 1934 and 1979 were studied. Over this period the average tar yield decreased by 49%, the nicotine yield by 31%, the carbon monoxide yield by 11%, all estimated on a sales-weighted basis. The average tar yield decreased progressively after the second world war, owing both to the introduction of filter cigarettes and to changes in the manufacture of plain cigarettes. The average nicotine yield increased initially, decreased by 43% from about 1950 to 1974, but increased again by 9% between 1974 and 1979. The average carbon monoxide yield started to decrease after about 1961; while it decreased substantially in plain cigarettes, the rapid increase in sales of filter cigarettes at this time, at the expense of plain cigarettes, largely offset the reduction in carbon monoxide yield that would otherwise have occurred. As with nicotine, carbon monoxide yield showed a small rise in later years (4% between 1976 and 1979). The trends in tar yield may well explain the reduction in lung cancer in the UK better than has been suspected hitherto. The trends in nicotine and carbon monoxide yields are probably not sufficiently different to distinguish which of them might be the more likely cause of cardiovascular disease.     

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.     

Modifying risk of developing lung cancer by changing habits of cigarette smoking

Data from a hospital based case-control study of lung cancer in Western Europe were used to examine changes in the risk of developing lung cancer after changes in habits of cigarette smoking. Only data for subjects who had smoked regularly at some time in their lives were included. The large size of the study population (7181 patients and 11 006 controls) permitted precise estimates of the effect of giving up smoking. Risks of developing lung cancer for people who had given up smoking 10 or more years before interview were less than half of those for people who continued to smoke. The reduction in risk was seen in men and women and in former smokers of both filter and non-filter cigarettes but varied by duration of smoking habit before giving up. The protective effect of giving up became progressively greater with shorter duration of smoking habit. The risks after not smoking for 10 years for both men and women who had previously smoked for less than 20 years were roughly the same as those for lifelong non-smokers. Reducing the number of cigarettes smoked a day or switching from non-filter to filter cigarettes also lowered the risk of developing lung cancer but not to the extent associated with giving up smoking.     

Cigarette smoking and the risk of myocardial infarction, and acute non-infarct coronary events among Malaysian women

In a prospective case-control study over a two-year period involving 1006 women, 264 women with acute myocardial infarction (AMI), 305 with non-infarct acute coronary syndromes (CAD) were compared with 437 women with no coronary heart disease (Controls), to determine the relationship between cigarette smoking and other risks factors with coronary heart disease. A history of current cigarette smoking was strongly associated with the risk of coronary events for both AMI And CAD (p less than 0.001). 23.9% of patients with acute coronary syndromes were current smokers, compared with only 12.8% among controls. Overall, women smokers had about a two-fold increase in risk for all coronary events. Younger women smokers (less than 40 years) and those between 61-70 years had particularly higher risks (10.3 and 2.7 times respectively (p less than 0.01, p less than 0.02). A dose-response pattern of increased AMI risks (from 2.0 to 2.9 times) among women smokers was also found, corresponding to the number of cigarettes smoked per day (p less than 0.05). Other significant coronary risk factors established were: postmenopausal status (OR 6.5), diabetes mellitus (OR 5.1), hypertension (OR 1.6), family history of premature coronary heart disease less than 50 years (OR 1.3) and use of oral contraceptive pills (OR 1.4). Our results thus emphasize that cigarette smoking is an important determinant of acute coronary events even among Malaysian women.     

Passive smoking and the risk of heart disease.

OBJECTIVE--This paper reviews the evidence that exposure to environmental tobacco smoke (ETS) increases the risk of heart disease death among persons who have never smoked (never-smokers). The annual number of heart disease deaths in the United States attributable to ETS is estimated, as is the individual risk of heart disease death for exposed never-smokers. DATA SOURCES--Nine epidemiologic studies and numerous experimental studies are available to evaluate the association of ETS and heart disease. DATA SYNTHESIS--The relative risk for never-smokers living with current or former smokers, compared with never-smokers living with nonsmokers, has ranged from 0.9 to 3.0 in nine studies. Seven studies were positive, one was positive for women but not men, and one was negative. Several studies have shown a dose-response relationship and have controlled for other risk factors. Evidence from experimental studies suggests that ETS can damage the cardiovascular system, via both short-term and long-term mechanisms. Assuming that the observed heart disease risk for those exposed to ETS is not an artifact of misclassification or confounding, approximately 35,000 to 40,000 deaths from ischemic heart disease among never-smokers and long-term former smokers are estimated to have occurred annually in the United States as a result of ETS exposure in the early 1980s. An individual male never-smoker living with a current or former smoker is estimated to have an approximately 9.6% chance of dying of ischemic heart disease by the age of 74 years, compared with a 7.4% chance for a male never-smoker living with a nonsmoker. The corresponding lifetime risks for women are 6.1% and 4.9%. CONCLUSIONS--The public health burden due to ETS exposure is likely to be much greater for heart disease than for lung cancer, which has been the focus of most debate to date. Individual lifetime excess risks of heart disease death due to ETS of one to three per 100 can be compared with much lower excess risks of one death per 100,000, which are often used in determining environmental limits for other toxins. Exposure to ETS is not currently regulated at the federal level, except for domestic air traffic.     

文化程度对男性吸烟行为的群体效应和个体效应:中国心血管病流行病学多中心协作研究

目的探讨文化程度在中国男性吸烟行为发生过程中的群体效应及个体效应。方法通过标准化问卷对我国不同地区15个人群,共计7415名35～59岁男性调查其文化程度和吸烟行为状况。将研究人群分为两类:Ⅰ类人群大专以上学历平均占25.8%,Ⅱ类人群大专以上学历占2.0%。分析文化程度在人群内和两类人群间对吸烟行为的影响。结果(1)在Ⅰ类人群中,曾吸烟率、现吸烟率、深吸烟率、因病戒烟者所占比例和吸烟量分别为66.2%、56.4%、34.4%、47.8%、17.2支/d,均显著低于Ⅱ类人群的75.8%、64.4%、40.3%、58.4%、20.4支/d。(2)同Ⅰ类人群大专以上学历组相比,Ι类男性高中学历组吸烟危险为1.8(95%CI:1.5～2.1),初中及以下学历组为2.0(95%CI:1.7～2.5);Ⅱ类男性大专以上学历组吸烟危险为1.4(95%CI:0.9～2.1),高中学历组为1.7(95%CI:1.4～2.1),初中及以下学历组为2.4(95%CI:2.1～2.8)。结论个体文化程度和群体文化水平共同影响吸烟行为发生。发展教育对控烟工作具有积极意义,提高群体受教育水平和通过健康促进创造群体抗烟环境应是今后控烟工作的重要手段。     

Effects of smoking on health care costs

Smoking is the leading preventable cause of death in the United States. The US Centers for Disease Control and Prevention (CDC) estimate that smoking kills approximately 419,000 people in the United States each year. Cigarette smoking is the nation's leading cause of premature mortality, and is responsible for one-third of all deaths among working-age Americans. Smoking cigarettes is both psychologically and physiologically addictive. Smoking is an important risk factor for cardiovascular diseases, especially coronary artery disease, stroke, carcinoma of the lung, chronic bronchitis, chronic obstructive pulmonary disease, and emphysema. It also increases the risk for peripheral vascular disease and is associated with cancers of the larynx, oral cavity, esophagus, pancreas, and urinary bladder. Smoking by pregnant women can cause adverse health effects on their babies, like low birth weight and preterm delivery; increases the risk of miscarriage; and has also been found to be an important cause of sudden infant death syndrome. Careless smoking also can cause severe burn injuries and death. Many of these adverse effects of smoking occur in "second-hand" smokers.     

Non-smoking wives of heavy smokers have a higher risk of lung cancer: a study from Japan

In a study in 29 health centre districts in Japan 91 540 non-smoking wives aged 40 and above were followed up for 14 years (1966-79), and standardised mortality rates for lung cancer were assessed according to the smoking habits of their husbands. Wives of heavy smokers were found to have a higher risk of developing lung cancer and a dose-response relation was observed. The relation between the husband's smoking and the wife's risk of developing lung cancer showed a similar pattern when analysed by age and occupation of the husband. The risk was particularly great in agricultural families when the husbands were aged 40-59 at enrolment. The husbands' smoking habit did not affect their wives' risk of dying from other disease such as stomach cancer, cervical cancer, and ischaemic heart disease. The risk of developing emphysema and asthma seemed to be higher in non-smoking wives of heavy smokers but the effect was not statistically significant. The husband's drinking habit seemed to have no effect on any causes of death in their wives, including lung cancer. These results indicate the possible importance of passive or indirect smoking as one of the causal factors of lung cancer. They also appear to explain the long-standing riddle of why many women develop lung cancer although they themselves are non-smokers. These results also cast doubt on the practice of assessing the relative risk of developing lung cancer in smokers by comparing them with non-smokers.     

Trends in mortality among California physicians after giving up smoking: 1950-79

A study was conducted to assess how lung cancer and other mortality trends among California physicians had been influenced by the high proportion who had given up smoking since 1950. Several sample surveys indicated that the proportion of California physicians who currently smoked cigarettes had declined dramatically from about 53% in 1950 to about 10% in 1980. During the same period the proportion of other American men who smoked cigarettes had declined only modestly, from about 53% to 38%. Using the 1950 American Medical Directory a cohort of 10 130 California male physicians was established and followed up for mortality till the end of 1979, during which time 5090 died. The information from follow up and death certification was exceptionally good. The standardised mortality ratio for lung cancer among California male physicians relative to American white men declined from 62 in 1950-9 to 30 in 1970-9. The corresponding decline in standardised mortality ratio was from 100 to 63 for other smoking related cancer, from 106 to 71 for ischaemic heart disease, and from 62 to 35 for bronchitis, emphysema, and asthma. The standardised mortality ratio remained relatively constant for other causes of death not strongly related to smoking. The overall ratio declined in all age groups at a rate of about 1% a year. The total death rate among all physicians converged towards the rate among non-smoking physicians. By the end of the study period physicians had a cancer rate and total death rate similar to or less than those among typical United States non-smokers. This "natural experiment" shows that lung cancer became relatively less common on substantial elimination of the primary causal factor, cigarette smoking. Other smoking related diseases also became relatively less common, though factors other than cigarette smoking may have contributed to this change.     

Pragmatic, observational study of bupropion treatment for smoking cessation in general practice

Background: Cigarette smoking remains the single largest cause of premature death in the United Kingdom. As part of the government''s national service framework for coronary heart disease, smoking cessation forms a key part of the strategy. Objectives: To determine the effectiveness of bupropion treatment for smoking cessation in a general practice setting, measuring continuous abstinence from smoking, from 8 weeks to 52 weeks. Design: Prospective observational study. Setting: One general practice (six whole time equivalent doctors, 11 070 patients) in rural Northumberland. Subjects: Of the 243 patients who presented to the practice over a one year period for smoking cessation, a total of 227 motivated people, who were appropriate for bupropion treatment as a pharmacological aid for smoking cessation, entered the study. Continuous smoking cessation at one year was validated by an exhaled carbon monoxide level of 10 ppm or less. Results: Fifty patients successfully gave up smoking, giving a one year smoking cessation prevalence with bupropion of 22% (95% confidence intervals (CI) 17% to 28%). There was no difference in success rate for sex, number of cigarettes smoked, the number of years smoking, or whether there were other smokers in the household or not. Conclusion: Bupropion treatment in this general practice helped 22% of motivated people to quit and remain stopped smoking at one year. Mainly nurses, whose prescribing rights are restricted and currently exclude bupropion, deliver smoking cessation services in primary care.     

Cigarette smoking and infertility in men

For this study of testosterone concentrations in 2 matched groups of men, 1 of lifelong nonsmokers and 1 of men smoking at least 30 cigarettes daily, 2 specimens of blood were collected with an interval of 7 days without smoking. The first specimens showed plasma testosterone to be higher in nonsmokers than in smokers, indicating that smoking decreases plasma testosterone. The difference in plasma testosterone between the 2 specimens from nonsmokers was insignificant, but in smokers the 2nd specimen showed a statistically significant increase in testosterone concentration. Reduced testosterone biosynthesis caused by carbon monoxide inhibition of Leydig cell microsomal hydroxylases seems to be the probable explanation of this effect. The possibility thus exists that cigarette smoking can contribute to infertility in men.     

Cigarette smoking and exposure to passive smoke are risk factors for cervical cancer

Personal cigarette smoking and exposure to passive smoke as risk factors for cervical cancer were examined in a population-based, case-control study conducted in Utah. Personal cigarette smoking was found to increase the risk of cervical cancer, after adjusting for age, educational level, church attendance, and sexual activity. The adjusted risk estimate associated with being a current smoker was 3.42 (95% confidence interval [Cl], 2.10 to 5.57); for having smoked for 5 or more pack-years, it was 2.81 (95% Cl, 1.73 to 4.55); and for having smoked at least 100 lifetime cigarettes, it was 2.21 (95% Cl, 1.44 to 3.39). The adjusted risk estimate (also adjusted for actual cigarettes smoked) associated with passive smoke exposure for 3 or more hours per day was 2.96 (95% Cl, 1.25 to 7.03). Risk from passive smoking was greater in women who were not smokers (odds ratio, 3.43; 95% Cl, 1.23 to 9.54) than in women who smoked (odds ratio, 2.59; 95% Cl, 0.23 to 29.24).     

184例心血管疾病患者吸烟及戒烟现状调查分析

目的了解心血管疾病患者的吸烟及戒烟现状．方法对2010年12月至2011年12月期间在昆明市第一人民医院门诊或住院部就诊的184例心血管疾病患者进行戒烟问卷调查,分析心血管疾病患者吸烟及戒烟相关临床特征．结果（1）心血管疾病吸烟者中以男性为主（100％）,以患有高血压和／或冠心病为主（179人,97．3％）．（2）开始吸烟年龄平均21．5岁,其中97．8％患者烟龄≥108,平均（35．1±13．4）a,69．6％患者吸烟量≥10支,d,平均（16．3±10．1）支,d,65．8％的患者尼古丁依赖程度很低或是低度,81．5％患者认为戒烟重要,76．1％有戒烟想法,67．4％有信心成功戒烟,50．5％认为戒烟是件困难的事情;其中127人（69％）认真戒过烟．（3）认真戒烟患者有65例（51．2％）戒烟成功,其中54例（83．1％）接受过医务人员不同程度建议戒烟劝导;62例（48．8％）复吸,只有34例（54．8％）接受过医务人员建议戒烟劝导,2组进行Х^2检验,P=0．000,提示差异有统计学意义．其复吸原因主要因为压力、烟瘾发作及其身边有其他吸烟者．结论心血管疾病吸烟患者主要由患高血压和／或冠心病的男性患者构成;大多数患者认识到戒烟重要,有想法及认真戒烟,但由于缺乏信心及吸烟也成为一种生活习惯明显影响成功戒烟;医务人员的建议戒烟劝导在很大程度上提高了患者的戒烟成功率．     

2008年中国心血管专科医师的吸烟现状

目的 了解中国心内科医师吸烟现状及吸烟危害.方法 2008年6月1日至8月31日,在中国大陆的31个省、自治区、直辖市,共386家综合性医院心内科开展流行病学调查,共收集4032名有执业医师资格的心内科医师资料.结果 中国心内科医师的吸烟率为15.2%(95%CI14.1%～16.3%),其中男性为609名(29.8%)(95%CI 27.8%～31.8%),高于女性的3名(0.2%)(95%CI 0.1%～0.4%)(P<0.01).男性重度吸烟比例为6.9%(95%CI 5.9%～8.1%),女性未见重度吸烟者.男性吸烟率的分布有地区间差异,西北、西南地区较高.男性吸烟组有高血压、糖尿病、高脂血症等疾病史的比例均高于非吸烟组(均P<0.01);用Framingham量表和国人量表评估的10年心血管疾病绝对风险和相对风险,均为男性吸烟组高于非吸烟组(均P<0.01).结论 中国男性心血管医师吸烟率较高,应加强对该人群的戒烟.     

Would a medium-nicotine, low-tar cigarette be less hazardous to health?

Smoking behaviour and exposure to carbon monoxide, nicotine, and tar were studied in 19 middle-tar smokers. All smoked their own brands for three weeks and then switched to either a conventional low-nicotine, low-tar brand (control) or a medium-nicotine, low-tar cigarette for a further three weeks, the order then being reversed. The medium-nicotine, low-tar brand also had a low delivery of carbon monoxide. With the medium-nicotine, low-tar cigarette mouth-level delivery and intake of nicotine was similar to that with the smokers' usual brands, and significantly greater than with the control low-tar cigarette. Intake of carbon monoxide from the medium-nicotine, low-tar cigarette was significantly less than with either own or control brands. With both low-tar brands mouth-level exposure to tar was reduced relative to smokers' usual cigarettes. There was no evidence, however, that the reduction in tar exposure was greater with the medium-nicotine brand than with the control low-tar cigarette. Both low tar brands were "'oversmoked" relative to subjects' usual middle-tar cigarettes. The medium-nicotine, low-tar cigarette was marginally more acceptable than the control brand, and the particular design used in the study resulted in a lower intake of carbon monoxide. In terms of reducing mouth-level exposure to tar, however, the medium-nicotine, low-tar cigarette had no advantage over the control low-tar product. In part this was because of the ratio of tar to nicotine delivery obtained by human smokers was not the same as that obtained by smoking machine.