The sociodemographic pattern of tobacco cessation in the 1980s: results from a panel study of living condition surveys in Sweden.

STUDY OBJECTIVES: To analyse the factors that determined whether or not people were successful in quitting tobacco during the 1980s in Sweden. DESIGN: A logistic regression model was used for the analyses and included: education, marital status, socioeconomic group, social network, physical activities, cigarette consumption, and years spent smoking as independent variables. Men and women were analysed separately for smoking. A specific univariate analysis was also performed for men who used snuff. SETTING: Sweden. PARTICIPANTS: A panel of 5104 randomised people aged 16-84 years was interviewed in 1980-81 and followed up in 1988-89 in the survey of living conditions undertaken by Statistics Sweden. The participation rate was 86%. The panel included 1546 men and women who were daily smokers. There were 418 daily users of snuff among the men, and 129 men both smoked and used snuff. MAIN RESULTS: Together 26% of women and 23% of men had quit smoking. Five percent in both groups were new smokers. Among men, 26% had quit using snuff and 5% had begun smoking. New snuff users among men were 5%. In the multivariate analysis, unmarried men kept smoking at significantly higher rates (OR 2.1; 95% CI 1.2,3.6), as did those men who smoked 11-20 cigarettes/day (OR 2.2; 95% CI 1.5, 3.4), or more than 20 cigarettes/day (OR 2.8; 95% CI 1.4,5.7). Among women, smoking 11-20 cigarettes/day was also a significant factor (OR 3.3; 95% CI 2.1,5.0). Men and women aged 25-44 were significantly more likely to continue smoking (OR = 2.1; 95% CI 1.1,3.7, and 2.2; 95% CI 1.2,4.4) as were those who had smoked for 20 years or more (OR 4.7; 95% CI 2.0,10.8 and OR 2.5; 95% CI 1.1,5.5, respectively). For women, low education (up to grade 9) was also a significant factor (OR = 2.5; 95% CI 1.2,5.1). Among men who had quit using snuff we did not find any values of significance. CONCLUSIONS: One in four smokers had quit during the 1980s and a few started smoking (5%). Some men quit smoking and started using snuff instead. For both sexes, the daily consumption of cigarettes, years spent smoking, and age were the most important determinants of successful quitting. In men, being married/ cohabiting was an important factor as was higher education in women.     

Use of smoking-cessation treatments in the United States

BACKGROUND: Health promotion efforts encourage smokers to quit and to use effective cessation treatments. Randomized controlled trials demonstrate that medications and behavioral treatments improve cessation rates, but retrospective surveys have been inconsistent. This study assessed frequency of quit attempts, use of treatments for cessation, and abstinence rates among treatment users and non-users. METHODS: Data were analyzed from the 2003 Tobacco Use Special Cessation Supplement to the Current Population Survey. Participants included 29,537 U.S. smokers aged > or =18 years who smoked daily 12 months before the survey. Outcome measures included past-year quit attempts; use of behavioral, pharmacologic, and alternative treatments; receipt of social support; and abstinence for > or =4 weeks at time of survey. RESULTS: Approximately 43.5% of smokers reported a quit attempt in the preceding year: 64.2% of attempters used no cessation treatments; 8.8% used behavioral treatment; 32.2% used medication; and 14.1% used more than one treatment. Social support was reported to have been received by 24.1%. More nicotine-dependent smokers were more likely to use medications (OR=3.58; 95% CI=3.04-4.20). At the time of the survey, 19.3% of attempters were abstinent > or =4 weeks. Smokers who sought treatment were less likely to be abstinent (OR=0.75; 95% CI=0.67-0.84), and those who sought multiple treatments were even less likely to be abstinent. CONCLUSIONS: Many U.S. smokers make quit attempts, but most do not use behavioral or pharmacologic treatments. More nicotine-dependent smokers were more likely to seek treatment. Smokers who sought treatment were less likely to report abstinence, probably due to biased self-selection and recall. Retrospective survey data are not well-suited to assess the effectiveness of treatment.     

Nondaily smokers should be asked and advised to quit

BACKGROUND: Nondaily smokers are a growing subpopulation of smokers. Current cessation guidelines were developed for daily smokers, and how clinicians might help nondaily smokers is not clear. METHODS: Analyzing the 2000 National Health Interview Survey in 2004, we compared characteristics of nondaily smokers with never smokers and daily smokers. We used multivariate logistic regression to compare predictors of wanting to quit in 6 months between nondaily and daily smokers. RESULTS: About one in five current smokers was a nondaily smoker. Nondaily smokers reported better health than daily smokers, but had some health status indicators suggesting worse health than never smokers. Nondaily smokers were more likely to want to quit (odds ratio [OR]=1.31, 95% confidence interval [CI]=1.10-1.56) than daily smokers, but were less likely to report a physician having asked about tobacco use (41% vs 50%, p<0.0001) or advised quitting (31% vs 41%, p<0.0001). In both nondaily and daily smokers, physician advice (nondaily OR=1.50, 95% CI=1.03-2.2; daily OR=1.58, 95% CI=1.32-1.89), and the belief that secondhand smoke harms others (nondaily OR=1.48, 95% CI=1.04-2.1; daily OR=1.80, 95% CI=1.56-2.1), predicted wanting to quit. Higher-educated nondaily smokers were less likely to want to quit (OR=0.54, 95% CI=0.32-0.91), unlike in daily smokers (OR=1.48, 95% CI=1.15-1.89). Latino nondaily smokers were less likely (OR=0.43, 95% CI=0.30-0.64) than whites, and African-American daily smokers were more likely (OR=1.27, 95% CI=1.04-1.55) than whites, to want to quit. CONCLUSIONS: While daily smokers may seem a higher cessation priority, nondaily smokers may be more likely to quit with brief interventions. Cessation messages should address health risks of any smoking, ethnic differences, smoke-free messages, and situational triggers.     

Epidemiology of smoking among Kuwaiti adults: prevalence, characteristics, and attitudes

INTRODUCTION: In 1996 we conducted a cross-sectional survey to study the epidemiology of smoking among Kuwaiti adults. METHODS: The 4000 participants were selected using a three-stage stratified cluster sampling design. Altogether 3859 participants (1798 males, 2061 females) returned a completed self-administered questionnaire. RESULTS: The prevalence of smoking was 34.4% (95% confidence interval (CI) = 32.2-36.6) among men and 1.9% (95% CI = 1.3-2.5) among women. Among men, the highest prevalence (56.5%; 95% CI = 36.2-76.8) was observed in the youngest age group (< or = 20 years). Among women the highest prevalence was observed in one of the older age groups (46-50 years) (7.1%; 95% CI = 3.1-11.1). Multiple logistic regression analysis showed that the following factors were independently associated with smoking: lower levels of education (odds ratio (OR) 3.5; 95% CI = 1.5-8.4), lower employment grade (OR = 4.1; 2.5-6.7), and being a separated, divorced, or widowed woman (OR = 4.9; 95% CI = 2.0-11.8). The majority of smokers (68%) began smoking when younger than 20 years; significantly more men (70%) than women (33%) began smoking at these ages (P < 0.0001). On average, men began smoking at an earlier age (18 years vs 21 years; P < 0.001) and therefore had smoked for a longer period (15 years vs 12 years; P < 0.05); men also consumed a higher number of cigarettes each day (26 vs 17; P < 0.05). A large proportion of smokers were ignorant about the health consequences of passive smoking: about 77% of those with children reported that they smoked in the presence of their children. Almost half (47%) of all smokers stated that they wanted to stop smoking, and about 56% had attempted to quit. The biggest perceived barrier to quitting was uncertainty about "how to quit". A total of 338 respondents (8.8%; 95% CI = 5.8-11.9) were classified as former smokers. About half of the former smokers had quit between the ages of 20 and 29 years; the average age of quitting was 28 years. Former smokers were more likely to have smoked fewer cigarettes per day and to have smoked for significantly less time than current smokers. DISCUSSION: Given the fact that free education is provided at all levels by the government, anti-tobacco education and awareness should be included as an integral part of the curriculum in schools and colleges.     

The effect of smoke-free homes on smoking behavior in the U.S

BACKGROUND: Evidence from longitudinal population surveys is needed to establish whether smoke-free homes might influence smoking behavior. METHODS: The Tobacco Use Supplement of the nationally representative U.S. Current Population Survey (TUS-CPS) interviewed 3292 adult recent smokers in 2002 and again 12 months later. Both surveys measured smoking status, rules on smoking in the home, and the number of cigarettes smoked per day (cpd). For the main study outcome, an early marker of successful cessation (>/=90 days quit) was used. Analysis was completed in 2008. RESULTS: In the 12 months ending February 2003, the prevalence of smoke-free homes among recent smokers increased from 33% to 39%. A smoke-free home at baseline was associated with >/=90 days cessation at follow-up (10.9% vs 6.2%, AOR=1.44; 95% CI=0.97, 2.21), and those who maintained a smoke-free home were more likely to be >/=90 days quit than those who did not (12.9% vs 5.7%, AOR=1.99; 95% CI=0.93, 4.25). However, adopting a smoke-free home during the year was associated with a nearly fivefold increase in the percentage of >/=90 days quit (AOR=4.81; 95% CI=3.06, 7.59). This increase was seen among all smokers, including moderate-to-heavy smokers (>/=90 days quit: a smoke-free home=13.0% vs no smoke-free home=2.9%, p<0.001). Among continuing smokers with a smoke-free home at baseline, maintenance of the smoke-free home was associated with a decline in consumption (mu=-2.18; 95% CI=-1.24; -3.10 cpd). Among continuing smokers with no smoke-free home at baseline, adoption of that status was also associated with a decline in consumption (mu=-1.72; 95% CI=-0.58; -2.85 cpd). CONCLUSIONS: This study provides strong evidence that the adoption of a smoke-free home is associated with successful quitting among smokers in the U.S.     

Smoking frequency among current college student smokers: distinguishing characteristics and factors related to readiness to quit smoking

Given the increased prevalence of non-daily smoking and changes in smoking patterns, particularly among young adults, we examined correlates of smoking level, specifically motives for smoking, and readiness to quit smoking among 2682 college undergraduates who completed an online survey. Overall, 64.7% (n = 1736) were non-smokers, 11.6% (n = 312) smoked 1-5 days, 10.5% (n = 281) smoked 6-29 days and 13.2% (n = 353) were daily smokers. Ordinal regression analyses modeling smoking level indicated that correlates of higher smoking level included having more friends who smoke (β = 0.63, 95% CI 0.57-0.69) and more frequent other tobacco use (β = 0.04, 95% CI 0.02-0.05), drinking (β = 0.04, 95% CI 0.02-0.07) and binge drinking (β = 0.09, 95% CI 0.06-0.13). Bivariate analyses indicated that daily smokers (versus the subgroups of non-daily smokers) were less likely to smoke for social reasons but more likely to smoke for self-confidence, boredom, and affect regulation. Controlling for sociodemographics, correlates of readiness to quit among current smokers included fewer friends who smoke (P = 0.002), less frequent binge drinking (P = 0.03), being a social smoker (P < 0.001), smoking less for self-confidence (P = 0.04), smoking more for boredom (P = 0.03) and less frequent smoking (P = 0.001). Specific motives for smoking and potential barriers to cessation particularly may be relevant to different groups of college student smokers.     

Quit attempts among African American teenage smokers seeking treatment: gender differences

BACKGROUND: African Americans experience disproportionate smoking-related mortality. Because established smoking during youth predisposes to adult smoking and serious health consequences, characterizing ethnic differences in adolescent smokers' self-quit attempts may inform ethnic-specific approaches to youth smoking cessation. METHODS: African American and European American teenage smokers applying to a teenage smoking cessation study (2000-2003) provided smoking-related data, including characteristics of previous cessation attempts and prior use of nicotine replacement therapy (NRT). Tobacco dependence was assessed using the Fagerstrom Test of Nicotine Dependence (FTND). RESULTS: Of 980 (15.5 +/- 1.3 years, 41.8% African American, 59.9% female) participants, African Americans boys were significantly less likely than European American boys to report a prior quit attempt (OR = 0.35, 95% CI 0.17-0.73, P = 0.0049) or to have used NRT (OR = 0.60, 95% CI 0.36-0.998, P = 0.049) after adjusting for years smoked and FTND score. African American girls were more likely to report a prior request for cessation treatment than European American girls after adjusting for FTND and years smoked (OR = 2.19, 95% CI 1.37-3.48, P = 0.001). CONCLUSIONS: While increasing education and outreach to African American boys and enhancing access to formal cessation programs for African American girls who smoke may be beneficial, our findings warrant extension to non-treatment-seeking teenage smokers.     

甘肃省15～69岁现在吸烟者戒烟意愿及影响因素

  目的  了解甘肃省现在吸烟者的戒烟意愿以及影响因素,为烟草防控工作提供科学依据。  方法  采用多阶段抽样方法,随机抽取15~69岁现在吸烟者作为调查对象。采用《全国居民吸烟情况调查问卷》开展面对面调查,分析不同特征现在吸烟者的戒烟意愿,采用Logistic回归分析模型分析现在吸烟者戒烟意愿的影响因素。  结果  甘肃省现在吸烟者的戒烟意愿为16.4%（95%CI:15.5%~17.3%）,农村地区（OR=1.199,95%CI:1.022~1.408,P=0.026）、家中禁止吸烟（OR=1.767,95%CI:1.273~2.454,P=0.001）、12个月内就医时医务人员劝阻吸烟（OR=1.599,95%CI:1.359~1.842,P < 0.001）、去过戒烟门诊（OR=3.089,95%CI:2.031~4.698,P < 0.001）、初中、高中、大专及以上文化程度（OR=1.383,95%CI:1.101~1.736;OR=1.627,95%CI:1.252~2.116;OR=1.374,95%CI:1.009~1.873,均有P < 0.05）、高烟草危害知识得分为1~,3~,5~6（OR=1.248,95%CI:1.030~1.514;OR=1.574,95%CI:1.289~1.922;OR=2.288,95%CI:1.879~2.786,均有P < 0.05）是现在吸烟者戒烟意愿的促进因素;年龄20~、30~岁组以及烟龄20~、30~年是现在吸烟者戒烟意愿的阻碍因素。  结论  甘肃省现在吸烟者戒烟意愿总体不高,今后应进一步在全社会普及烟草危害知识,加强医务人员戒烟服务能力培训,在诊疗过程中开展戒烟服务,同时应鼓励和支持医疗机构加快戒烟门诊建设。     

The influence of maternal cigarette smoking, snuff use and passive smoking on pregnancy outcomes: the Birth To Ten Study

This article describes the patterns and effects of maternal snuff use, cigarette smoking and exposure to environmental tobacco smoke during pregnancy on birthweight and gestational age, in women living in Johannesburg and Soweto in 1990. A cohort of 1593 women with singleton live births provided information about their own and household members' usage of tobacco products during pregnancy. The women completed a questionnaire while attending antenatal services. Data on gestational age and birthweight were obtained from birth records. Women who smoked cigarettes or used snuff during pregnancy accounted for 6.1% and 7.5% of the study population respectively. The mean birthweight of non-tobacco users was 3148 g [95% CI 3123, 3173] and that of the smokers 2982 g [95% CI 2875, 3090], resulting in a significantly lower mean birthweight of 165 g for babies of smoking mothers (P = 0.005). In contrast, women using snuff gave birth to infants with a mean birthweight of 3118 g [95% CI 3043, 3192], which is a non-significant (P = 0.52) decrease (29.4 g) in their infants' birthweights compared with those not using tobacco. A linear regression analysis identified short gestational age, female infant, a mother without hypertension during pregnancy, coloured (mixed racial ancestry), and Asian infants compared with black infants, lower parity, less than 12 years of education and smoking cigarettes as significant predictors of low birthweight, while the use of snuff during pregnancy was not associated with low birthweight. The snuff users, however, had a significant shorter gestational age than the other two groups of women. The birthweight reduction adjusted for possible confounders was 137 g [95% CI 26.6, 247.3 (P = 0.015)] for cigarette smokers and 17.1 g [95% CI -69.5, -102.7, P = 0.69] for snuff users respectively, compared with the birthweight of non-tobacco users. Among women who did not smoke cigarettes or use snuff, exposure to environmental tobacco smoke did not result in significant effects on the birthweight of their infants. In conclusion, infants of cigarette smokers had significantly lower birthweights than those of non-tobacco users or snuff users who are exposed to nicotine during pregnancy. Passive smoking did not affect birthweight significantly in this population.     

Smoking cessation intervention practices in Chinese physicians: do gender and smoking status matter?

Healthcare settings provide a major arena for administering smoking cessation interventions. However, few studies have reported differences in the frequency of practice in healthcare professionals by gender and smoking status. This might also be influenced by a difference in smoking prevalence by gender, especially in China and other developing countries. This study examined factors associated with the frequency of cessation intervention practices by smoking status among Chinese physicians in men and women. A cross-sectional survey was conducted in 2006 in physicians with direct patient contact from nine hospitals in Guangzhou with a response rate of 60.8%. Significantly more female physicians who were non-smokers (79.7%) reported "initiation and/or advice" smoking cessation interventions than male physicians who were smokers (71.2%) and non-smokers (71.6%). Factors significantly associated with "initiation and/or advice" were prior smoking cessation training (OR = 4.2, 95% CI 1.8-9.6) and lack of knowledge to help patients to quit (OR = 0.4, 95% CI 0.2-0.9) among male physicians who smoked; and organisational support (OR = 1.7, 95% CI 1.3-2.2) and successful past experience (OR = 0.4, 95% CI 0.2-1.0) among male physicians who did not smoke. Among female physicians who did not smoke, significant factors were agreeing that quitting smoking is the most cost-effective way to prevent chronic disease and cancer (OR = 3.0, 95% CI 1.4-6.1), helping patients stop smoking is part of expected role and responsibility (OR = 2.0, 95% CI 1.0-3.7), lack of knowledge to help patients to quit (OR = 0.5, 95% CI 0.2-1.0) and organisational support (OR = 1.3, 95% CI 1.0-1.6) for non-smoking female physicians. This study is the first to show that male physicians were less likely to provide smoking cessation counselling regardless of their smoking status while non-smoking female physicians were more active in advising patients on quitting. The findings highlight the need for developing tailored smoking cessation training programmes for physicians according to their smoking status and gender in China.     

Ethnic and gender differences in smoking and smoking cessation in a population of young adult air force recruits

PURPOSE: To examine gender and ethnic differences in smoking and smoking cessation in a population of young adult military recruits. DESIGN: A self-administered survey of demographics, tobacco use, and other health risk behaviors was administered at the start of basic military training. SETTING: The study was conducted at Lackland Air Force Base, San Antonio, Texas, where all U.S. Air Force recruits complete basic military training. SUBJECTS: All recruits who entered the U.S. Air Force between September 1995 and September 1996 participated in this study (n = 32,144; 100% participation rate). MEASURES: Recruits completed a written 53-item behavioral risk questionnaire. Measures examined in the present study included smoking status (ever having smoked a cigarette, current daily smoking, and quitting); demographics (ethnicity, gender, education, family income, and age); smoking history; and nicotine dependence. RESULTS: Rates of ever smoking, current daily smoking, and quitting were examined in multiple logistic regression analyses as a function of gender and ethnicity, controlling for age, education, and family income. Overall, 54% of recruits had ever smoked a cigarette and 24.9% smoked daily at the time of entry into basic military training. Smoking rates were highest among white and Native American recruits. Among whites, women were more likely to be a current daily smoker (31.6% vs. 29.4%; odds ratio [OR] = 1.18, 99% confidence intervals [CI] = 1.08-1.29). The opposite pattern was observed among African-Americans (5.6% vs. 9.8%, respectively; OR = .57; CI = .41-.79). Current smokers had low levels of nicotine dependence compared with the general population of U.S. smokers, but whites tended to be more dependent than other ethnic groups. Cessation rates were similar for men and women but differed according to ethnicity, ranging from 15% among whites to 23% among Hispanics. CONCLUSIONS: These findings document important gender and ethnic differences in cigarette smoking among military recruits. Whites and Native Americans were more likely to smoke, less likely to quit, and more nicotine-dependent than other ethnic groups. Across gender/ethnicity groups, smoking rates were especially high among white women, with nearly one-third smoking daily until entry into basic training. Gender differences were not observed in cessation rates, but Hispanics were more likely than other ethnic groups to have quit smoking. The results highlight the need to develop effective cessation interventions for this population.     

Correlates of smoking in pregnant women in six Brazilian cities

OBJECTIVE: To evaluate sociodemographic and lifestyle correlates of smoking in pregnant women sampled from hospitals. METHODS: A cross-sectional study was conducted in 5,539 pregnant women aged 20 or more who sought medical attention in prenatal clinics of affiliate hospitals of the Brazilian National Health System in the cities of Manaus, Fortaleza, Salvador, Rio de Janeiro, S?o Paulo, and Porto Alegre from 1991 to 1995. Interviews were conducted using a standardized questionnaire that covered sociodemographics and smoking habits before and during pregnancy. Current smoking was defined as smoking at least one cigarette/day, former smoking as reporting having smoked at least one cigarette/day but having quit, and never smoking as never having smoked one cigarette/day. RESULTS: Smoking during pregnancy was associated with lower education (OR=2.13; CI 95%: 1.76-2.57) and greater parity (OR=1.84; CI 95%: 1.53-2.21). Positive associations were also found with increased gestational age and alcohol consumption. No significant association was found with skin color or occupation status. A protective effect was observed for women married or living with a partner (OR=0.55 CI 95%: 0.42-0.72). Having Manaus' women as a reference, Porto Alegre's women showed the greatest risk for smoking in pregnancy (OR=5.00; CI 95%: 3.35-7.38), followed by S?o Paulo's (OR=3.42; CI 95%: 2.25-5.20), Rio de Janeiro (OR=2.53; CI 95%: 1.65-3.88) and Fortaleza's (OR=2.56; CI 95%: 1.74-3.78). CONCLUSIONS: The study findings are similar to those described in the literature regarding education, parity, and marital status. However, no association with skin color was seen in the multivariate analysis. Former smokers had sociodemographic characteristics more similar to non-smokers than former smokers.     

Smoking behaviors among immigrant Asian Americans: rules for smoke-free homes

BACKGROUND: Higher acculturation is associated with Asian-American smoking prevalence decreasing in men and increasing in women. Asian immigrants in California are significantly more likely than their counterparts in Asia to have quit smoking. Smoke-free environments may mediate this acculturation effect because such environments are not widespread in Asia. METHODS: In 2006, Asian-American current and former smokers were analyzed using the 2003 California Health Interview Survey. A multivariate logistic regression analysis examined how the interaction between having a smoke-free-home rule and immigrating to the U.S. is associated with status as a former smoker and lighter smoking. RESULTS: For recent Asian immigrants (<10 years in the U.S.) and longer-term residents (born/>or=10 years in the U.S.), having a smoke-free-home rule was associated with status as a former smoker (OR 14.19, 95% CI=4.46, 45.12; OR 3.25, 95% CI=1.79, 5.90, respectively). This association was stronger for recent immigrants (p=0.02). Having a smoke-free-home rule was associated with lighter smoking only for longer-term residents (OR 5.37, 95% CI=2.79, 10.31). CONCLUSIONS: For Asian Americans, smoke-free-home rules are associated with status as a former smoker, particularly among recent immigrants, and lighter smoking in long-term residents. Interventions encouraging Asian Americans to adopt smoke-free-home rules should be evaluated.     

Influence of smoking and snuff cessation on risk of preterm birth

The mechanisms by which antenatal smoking exposure increases the risk of preterm birth remain unknown. Swedish oral moist snuff contains quantities of nicotine comparable to those typically absorbed from cigarette smoking, but does not result in exposure to the products of combustion, for example carbon monoxide. In a nation-wide study of 776,836 live singleton births in Sweden from 1999 to 2009, the authors used multiple logistic regression models to examine associations between cessation of smoking and Swedish snuff use early in pregnancy and risk of preterm birth (before 37 weeks). Compared with non-tobacco users both before and in early pregnancy, the adjusted odds ratios (OR), 95% confidence interval (CI) were OR=0.92, 95% CI 0.84-1.01, for women who stopped using snuff, and OR=0.90, 95% CI 0.87-0.94, for women who stopped smoking. In contrast, continued snuff use and smoking were associated with increased risks of preterm birth (adjusted OR=1.29, 95% CI 1.17-1.43, adjusted OR=1.30, 95% CI 1.25-1.36, respectively). The snuff and smoking-related risks were, if anything, higher for very (before 32 weeks) than moderately (32-36 weeks) preterm birth, and also higher for spontaneous than induced preterm birth. These findings suggest that antenatal exposure to nicotine is involved in the mechanism by which tobacco use increase the risk of preterm birth.     

Trends in smoking before,during, and after pregnancy in ten states

BACKGROUND: While trends in smoking prevalence during pregnancy are known, little is known about trends in quitting during pregnancy and resuming smoking after pregnancy. OBJECTIVES: This study examined the trends in and correlates of quitting during pregnancy and resuming smoking after pregnancy. METHODS: We used population-based random surveys of recent mothers in ten U.S. states (total of 115,000 women) conducted between 1993 and 1999. RESULTS: Although the prevalence of smoking 3 months before pregnancy was stable at around 26%, quitting during pregnancy rose from 37% to 46% between 1993 and 1999. Adjusted for maternal and state characteristics, the odds of quitting during pregnancy increased 51% between 1993 and 1999 (odds ratio [OR]=1.51; 95% confidence interval [CI]=1.08-2.12). Approximately half of the women who quit smoking during pregnancy resumed smoking within 6 months postpartum. Primiparous, privately insured, college-educated women are more likely to quit and least likely to resume smoking after delivery, compared to multiparous, Medicaid-insured, and high school-educated women. Teenaged women are more likely to quit, but also more likely to resume smoking than older women. CONCLUSIONS: The increase in quit rates during pregnancy is encouraging, but the lack of any change in smoking before pregnancy or in postpartum relapse rates suggests that permanent changes in maternal smoking will require additional focus.     

Getting focused: missed opportunities for smoking interventions for pregnant women receiving Medicaid

BACKGROUND: The prevalence of smoking, and cessation and relapse rates for pregnant women have health and financial implications. Our objectives were to describe smoking among pregnant smokers receiving Medicaid including characteristics associated with reporting discussion of smoking with providers and the association between those discussions with quitting and maintenance. METHODS: Analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data from 15 states for 20,287 women with Medicaid for prenatal care during 1998-2000. RESULTS: Thirty-four percent of women smoked before pregnancy (N = 7,686). Most smokers (93%) and nonsmokers (88%) reported discussions about smoking during prenatal care. Women were less likely to have discussed smoking if they were lighter smokers (OR = 1.47; CI = 1.03, 2.12), or reported a previous low-birthweight infant (OR = 1.72; CI = 1.03-2.86). Women reporting discussions (compared to those not) were less likely to quit (ARR = 0.70: CI = 0.59-0.91). Quitters reporting discussions (compared to those not) were no more likely to maintain cessation (ARR = 0.89; CI = 0.7, 1.21). CONCLUSIONS: Smoking cessation interventions can be improved for pregnant women receiving Medicaid, especially if focused to address individual needs of light smokers, those with previous low-birthweight infants, or those who find it most difficult to quit.     

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.     

The use of nicotine-replacement therapy by hospitalized smokers

BACKGROUND: No-smoking policies are mandatory in U.S. hospitals. Consequently, smokers who are hospitalized must temporarily stop smoking. Nicotine-replacement therapy (NRT) could help hospitalized smokers relieve nicotine withdrawal symptoms, comply with no-smoking policies, and sustain tobacco abstinence after discharge. The extent of NRT use in the hospital setting is unknown. We describe the prevalence and patterns of NRT use in hospitalized smokers. DESIGN: Prospective observational study within a randomized smoking-intervention trial. SETTING/PARTICIPANTS: Six hundred fifty adult smokers admitted to the medical and surgical services of a large urban teaching hospital that prohibits smoking in all indoor areas. Follow-up was at 6 months. MAIN OUTCOME MEASURE: Inpatient pharmacy records of nicotine patch or gum use. RESULTS: Only 34 of 650 smokers (5.2%) received NRT during their hospital stay, including only 9.6% of smokers who reported difficulty refraining from smoking while hospitalized and 9.0% of hospitalized smokers with nicotine withdrawal. NRT was more likely to be prescribed to patients with nicotine withdrawal (OR 2.23; 95% CI: 1.01, 4.90), a higher daily cigarette consumption (OR 1.04; 95% CI: 1.01, 1.06), and a longer hospitalization (OR 1.05; 95% CI: 1.00, 1.10). NRT use was independent of a patient's intention to quit smoking after discharge and was not associated with smoking cessation 1 and 6 months after discharge. CONCLUSIONS: NRT was rarely used in this hospital, even among those who could have benefited from it to treat nicotine-withdrawal symptoms. When NRT was used, relief of nicotine withdrawal, rather than assistance with smoking cessation, appeared to be the primary goal. Greater use of NRT could benefit the estimated 6.5 million smokers who are hospitalized annually by reducing nicotine withdrawal, encouraging smoking cessation, and ensuring compliance with hospital no-smoking policies.     

Electronic Cigarette Use Among Korean Adolescents: A Cross-Sectional Study of Market Penetration,Dual Use,and Relationship to Quit Attempts and Former Smoking

PurposeAs elsewhere, in South Korea electronic cigarettes (e-cigarettes) are marketed, in part, as a smoking cessation aid. We assessed the prevalence of e-cigarette use among Korean adolescents and the relationship between e-cigarette use and current (past 30-day) smoking, cigarettes/day, attempts to quit conventional cigarettes, and ceasing to use cigarettes.MethodsData from the 2011 Korean Youth Risk Behavior Web-based Survey of 75,643 students aged 13–18 years were analyzed with logistic regression.ResultsA total of 9.4% (8.0% ever–dual users who were concurrently using e-cigarettes and smoking conventional cigarettes and 1.4% ever–e-cigarette only users) of Korean adolescents have ever used e-cigarettes and 4.7% were current (past 30-day) e-cigarette users (3.6% dual users and 1.1% e-cigarettes only). After adjusting for demographics, current cigarette smokers were much more likely to use e-cigarettes than were nonsmokers. Among current cigarette smokers, those who smoked more frequently were more likely to be current e-cigarette users. The odds of being an e-cigarette user were 1.58 times (95% confidence interval, 1.39–1.79) higher among students who had made an attempt to quit than for those who had not. It was rare for students no longer using cigarettes to be among current e-cigarette users (odds ratio, .10; confidence interval, .09–.12).ConclusionsSome Korean adolescents may be responding to advertising claims that e-cigarettes are a cessation aid: those who had made an attempt to quit were more likely to use e-cigarettes but less likely to no longer use cigarettes. E-cigarette use was strongly associated with current and heavier cigarette smoking.     

Cigarette smoking and the risk of the metabolic syndrome in middle-aged Japanese male office workers

To examine the association between cigarette smoking and the risk of the metabolic syndrome (MS), 3649 Japanese male office workers aged 35-59 yr who did not have a history of cardiovascular disease were enrolled in this study. 2994 men without the MS at entry were followed up over a 7-yr period. A modified National Cholesterol Education Program definition with body mass index instead of waist circumference was used for the MS. With adjustment for age, family history of diabetes, alcohol intake, and regular physical activity, the odds ratios of the MS were 1.0 (referent), 1.30 (95% confidence interval (CI), 1.00-1.68), 1.07 (95% CI, 0.82-1.39), 1.17 (95% CI, 0.88-1.56), and 1.66 (95% CI, 1.24-2.20) for never smokers, ex-smokers, and those who smoked 1-20 cigarettes/d, 21-30 cigarettes/d, and > or =31 cigarettes/d, respectively (P for trend for current smokers only =0.006). As for the risk of developing the MS, the respective multivariate-adjusted hazard ratios of developing the MS were 1.0 (referent), 1.43 (95% CI, 1.14-1.79), 1.14 (95% CI, 0.91-1.44), 1.45 (95% CI, 1.14-1.84), and 1.59 (95% CI, 1.24-2.05) (P for trend for current smokers only =0.001). Among men without the MS at entry, body weight gain over 7 yr, compared with never smokers, was significantly higher in smokers who quit smoking. It is important for the prevention of the MS not only to quit smoking but also to prevent weight gain after smoking cessation.