Changing Smoking Patterns in Calvados (France)

The results of a population survey in Calvados (France) on smoking patterns are presented and discussed. At some time during their lives, 80 % of males and 20 % of females have indulged in smoking, 54 % and 14 % respectively are currently smoking. Cigarettes are the most widespread product smoked. Hand-rolled cigarettes are still used by males of older age-groups, particularly in rural areas, but are progressively replaced by commercial cigarettes. The proportion of ex-smokers increases with age but the resulting decrease in consumption is compensated by an earlier starting age among young males and by a larger proportion of smokers among young females. The differential behaviour of males and females towards smoking contrasts with attitudes observed in the United Kingdom and the United States, but the recent changes occurring in young females indicate a trend towards a more homogeneous distribution of smoking in both sexes, as in other countries, with its prospective health implications.     

Smoking cessation in women with cardiac risk

This article summarizes what is known about smoking among women, in particular the consequences of smoking on women's cardiac health. Smoking is recognized as a major independent cause of coronary heart disease, a condition that ranks first among the causes of death for middle-aged and older women. Women who stop smoking greatly reduce their risk of heart disease and other smoking-related illnesses. Research since the 1980 report of the US Surgeon General has been inconsistent in finding differences by gender in smoking cessation, and few approaches have been devised specifically for women. Several factors are of unique concern among women and potential barriers to smoking cessation, including weight concerns, negative affect regulation, and hormonal influences. More research is needed to determine whether these factors, when targeted specifically, improve cessation success rates among women.     

Smoking and age at menopause in women

Although women can expect to live one half of their adult lives beyond menopause, knowledge about this physiologic event and its various influences on subsequent health and quality of life remains incomplete. In Massachusetts we studied a population-based random sample of 7828 white women, aged 45 to 55 years (response rate, 77%). The median age at last menstruation for the sample is 51.4 +/- 0.19 (SE) years years, and we found no evidence of a secular trend towards a later age at menopause in the last 25 years. Current smokers reach menopause an average of 1.74 years earlier than nonsmokers (t = 3.78, p less than 0.01), but the quantity smoked has a negligible effect. Other potential correlates measured--education and marital status, number of children, and urban/rural residence--have little effect on the age at menopause. The results confirm earlier, more tentative findings from clinical populations.     

Smoking habits and circulating leptin in postmenopausal non-obese women

This study examined whether smoking habits affect the correlation between serum leptin levels and body mass index (BMI) in 101 postmenopausal Caucasian non-obese women, all aged 57-59years. Mean serum leptin level in the entire group was 19.8 +/- 12.3 ng/ml (mean +/- s.d.) and mean BMI was 25.3 +/- 3.5 kg/m2. These parameters correlated significantly to each other (r = 0.70, p < 0.001). Between those who have smoked regularly for more than 2 years (n = 26) and those who are ex-smokers or have never smoked (n = 75), serum leptin levels or BMI did not differ and the correlation between serum leptin and BMI was identical. This suggests that smoking habits do not influence circulating leptin in Caucasian postmenopausal non-obese women.     

Smoking cessation in women: effects of the menstrual cycle.

Ten females in the midcycle phase of the menstrual cycle, 10 females in the premenstrual phase of the menstrual cycle, and 10 males agreed to try and stop smoking for two consecutive days. The Smoking Motivation Questionnaire and Profile of Mood States Questionnaire (POMS) were completed by all subjects beforehand. On each "no smoking" day, the POMS and a Smoking Withdrawal Questionnaire were completed. Males and midcycle females achieved significantly greater smoking reduction than premenstrual females during the "no smoking" days. Premenstrual females reported becoming significantly more tired, confused, depressed, anxious, and irritable than midcycle females. Midcycle females reported only slight changes in feeling state during cigarette withdrawal. The position of the males was broadly intermediate between the two female groups.     

Smoking is a risk factor for decreased physical performance in elderly women

BACKGROUND: In 487 elderly women aged 65-77 years, we examined the association of smoking with physical performance measures of muscle function and whether the effect of smoking on physical performance measures is mediated through its effect on vitamin D or estrogen metabolism. METHODS: Timed rise, timed walk at normal and fast speed, grip strength, and serum biochemical measurements were compared between smokers, past smokers, and nonsmokers. Analysis of covariance was used to compare physical performance variables while adjusting for confounding variables. RESULTS: Compared to nonsmokers and past smokers, current smokers were significantly (p <.05) slower on timed rise and timed walk tests and had decreased grip strength. From multivariate analysis, smoking, age, total body fat, and serum 1,25(OH)(2)D examined as quartiles were predictors of physical performance measures. The effect of current smoking on physical performance was equivalent to a normal age-related decline in physical performance tests of 7-11 years depending on the test. CONCLUSIONS: The results of this study suggest that current smoking is a risk factor for decreased muscle strength leading to decreased physical performance in elderly women. The effect of smoking on physical performance is in part mediated by its effect on 1,25(OH)(2)D metabolism. Smoking may also have an independent effect on physical performance possibly by a direct effect on muscle or through an effect on vascular function.     

Smoking, smoking cessation, and risk of hip fracture in women

PURPOSE: To examine the effects of cigarette smoking and smoking cessation on the risk of hip fracture in women. PATIENTS AND METHODS: We studied 116,229 female nurses, 34 to 59 years of age at baseline in 1980, who were followed for up to 12 years. Smoking habits and the occurrence of incident hip fractures (n = 377) due to low or moderate trauma were self-reported on biennial mailed questionnaires. RESULTS: Compared with women who had never smoked, the age-adjusted relative risk (RR) of hip fracture among current smokers was 1.3 (95% confidence interval [CI] 1.0 to 1.7). The risk of hip fracture increased linearly (P = 0.09) with greater cigarette consumption (RR = 1.6, 95% CI 1.1 to 2.3 for 25 or more cigarettes per day). These associations were somewhat reduced by adjusting for other risk factors for osteoporosis (menopausal status, use of postmenopausal estrogen, physical activity, and intakes of calcium, alcohol, and caffeine): RR = 1.2, 95% CI 0.8 to 1.3 for all current smokers; RR = 1.4, 95% CI 0.9 to 2.1 for 25 or more cigarettes per day. Relative risks were further reduced when body mass index was added to the model. There was no apparent benefit from quitting smoking until 10 years after cessation. After 10 years, former smokers had a reduced risk of hip fracture (adjusted RR = 0.7, 95% CI 0.5 to 0.9) compared with current smokers. CONCLUSION: Smokers are at increased risk of hip fracture and their risk rises with greater cigarette consumption. Risk declines among former smokers, but the benefit is not observed until 10 years after cessation. Both the increased risk among current smokers and the decline in risk after smoking cessation are in part accounted for by differences in body weight.     

Smoking and the risk of psoriasis in women: Nurses' Health Study II

Background

Psoriasis is a common, chronic, inflammatory skin disorder. Smoking may increase the risk of psoriasis, but no prospective data are available on this relation.

Methods

We prospectively examined over a 14-year time period (1991-2005) the relation between smoking status, duration, intensity, cessation, and exposure to secondhand smoke, and incident psoriasis in 78,532 women from the Nurses Health Study II. The primary outcome was incident, self-reported, physician-diagnosed psoriasis.

Results

We documented 887 incident cases of psoriasis. Compared with those who had never smoked, the multivariate relative risk (RR) of psoriasis was 1.78 (95% confidence interval [CI], 1.46 to 2.16) for current smokers and 1.37 (95% CI, 1.17 to 1.59) for past smokers. Compared with nonsmokers, the multivariate RR of psoriasis was 1.60 (95% CI, 1.31 to 1.97) for those who had smoked 11-20 pack-years and 2.05 (95% CI, 1.66 to 2.53) for those who had smoked ≥21 pack-years. Compared with never smokers, the multivariate RR of psoriasis was 1.61 (95% CI, 1.30 to 2.00) for those who quit smoking <10 years ago, 1.31 (95% CI, 1.05 to 1.64) for 10-19 years ago, and 1.15 (95% CI, 0.88 to 1.51) for ≥20 years ago. Prenatal and childhood exposure to passive smoke was associated with an increased risk of psoriasis.

Conclusions

In this prospective analysis, current and past smoking, and cumulative measures of smoking were associated with the incidence of psoriasis. The risk of incident psoriasis among former smokers decreases nearly to that of never smokers 20 years after cessation.     

Smoking and atherosclerotic cardiovascular disease in women with lower levels of serum cholesterol

This cohort study of Koreans examines the relationship between smoking on atherosclerotic cardiovascular disease (ASCVD) and whether serum levels of total cholesterol modify the impact of smoking on ASCVD.

A 10-year prospective cohort study was carried out on 234,399 Korean women, ranging 40–69 years of age who received health insurance from the National Health Insurance Corporation and had a medical evaluation in 1993. The main outcome measures were hospital admissions and deaths from ischemic heart disease (IHD), cerebrovascular disease (CVD), and total ASCVD.

At baseline, 13,696 (5.8%) were current smokers and 105,755 (45.1%) had a total cholesterol <200 mg/dl. Between 1994 and 2003, 4534 IHD (176/100,000 person year), 7961 CVD (310/100,000 person year), and 2418 other ASCVD events (94/100,000 person year) occurred. In multivariate Cox proportional hazard models controlling for age, hypertension, hypercholesterolemia, diabetes and alcohol drinking, current smoking increased the risk of IHD [hazard ratio (HR) = 1.7 (95% CI: 1.5–1.9)], CVD [HR = 1.6 (95% CI: 1.5–1.6)], and total ASCVD events [HR = 1.6 (95% CI: 1.5–1.7)]. Throughout the range of serum cholesterol levels, current smoking significantly increased the risk of myocardial infarction and CVD, but not angina pectoris. There was no evidence of an interaction between smoking and serum cholesterol (p for interaction = 0.469, 0.612, and 0.905 for IHD, CVD, and total ASCVD, respectively).

This study demonstrated that smoking was a major independent risk factor for IHD, CVD and ASCVD in Korean women. A low cholesterol level confers no protective benefit against smoking-related ASCVD.     

Smoking and the risk of peptic ulcer disease among women in the United States

Although multiple studies support a causal relationship between smoking and peptic ulcers in men, data for women are limited. Therefore, we used data from the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, a nationally representative prospective study of US adults, to evaluate the impact of smoking on the incidence of peptic ulcers in women. The study cohort included 2851 women who had not been diagnosed as having a peptic ulcer prior to the baseline interview. Among these women, 140 (4.9%) developed peptic ulcer disease. During 12.5 years of follow-up, the estimated cumulative incidence of ulcers was 10.0% for current smokers, 6.4% for former smokers, and 5.4% for never smokers. After adjusting for age, education, regular aspirin use, coffee consumption, and use of alcohol, current smokers were 1.8 times more likely to develop ulcers than never smokers (95% confidence interval, 1.2 to 2.6); the risk of peptic ulcer increased as the amount smoked increased. During the time of this study, we estimate that approximately 20% of incident peptic ulcer cases among US women were attributable to cigarette smoking.     

Smoking status and differential white cell count in men and women in the EPIC-Norfolk population

The total white blood cell (WBC) count is reported to be an independent predictor of mortality in several prospective studies. We investigated the association between total and differential WBC counts and cigarette smoking habit in a cross-sectional population-based study of 6902 men and 8405 women 39-79 years of age participating between July 1994 and 1997 in the European Prospective Investigation of Cancer (EPIC-Norfolk) study. Main outcome measures included WBC, granulocyte, lymphocyte and monocyte counts measured at a baseline health check and self-reported cigarette smoking habit. The age- and body mass index-adjusted mean total WBC counts were 7.8, 6.4, and 6.2x10(3) per ul (P<0.0001) among male current, former and never smokers, respectively, and 7.4, 6.3 and 6.2x10(3) per ul (P<0.0001), respectively, in women. The greatest absolute and percentage differences between smoking groups were observed for the granulocyte count. Current smoking habit had a stronger effect on mean total WBC counts than cumulative exposure as measured by pack years. Among former smokers mean age- and body mass index-adjusted WBC, granulocyte and lymphocyte counts were inversely related to duration of smoking cessation (P< or =0.02). Smokers who had given up less than 12 months previously had WBC counts substantially lower (6.7 and 6.9x10(3) per ul, respectively, in men and women) than current smokers. In conclusion, the total WBC count and its components (particularly the granulocyte count) are strongly associated with cigarette smoking habit. Smoking cessation may have an almost immediate impact at least on pathophysiologic processes such as inflammation that may be indicated by the WBC count. The apparent almost immediate reversibility of effects of smoking on inflammation, as indicated by the WBC count, may help motivate efforts to stop smoking.     

Reproductive behaviour of HIV-infected women living in France, according to geographical origin.

Pregnancy rates were compared before and after HIV diagnosis according to geographical origin (sub-Saharan Africa versus Europe) among 533 HIV-infected women followed in the French SEROCO/SEROGEST cohorts between 1988 and 1996. Among European women, the incidence of deliveries and terminations decreased, respectively, by nearly twofold and fourfold after HIV diagnosis. Conversely, the pregnancy incidence increased among African women with fewer than two children. This study should help refine the reproductive counselling and management of HIV-infected women in France.     

Smoking in older women. Is being female a 'risk factor' for continued cigarette use?

Current national data indicate that a greater percentage of women entering their fifth and sixth decades of life are current, as opposed to former, smokers, while for men the opposite pattern is present. A representative sample of 1876 men and women aged 50 to 65 years living in a northern California community were interviewed to examine factors related to gender differences in quit rates in this age group. In this well-educated community, a significantly greater percentage of women (25.6%) continued to smoke relative to men (18.6%), with a greater percentage of men reporting being former smokers. Multivariate analysis revealed educational level and marital status, rather than gender, to be significant, Independent factors associated both with current cigarette use and with successful quitting. Our data indicate that it is not being female per se, but rather the disparities in educational level and marital status that are linked with being an older woman, that are associated with continued smoking in this age group. In light of this, delivery of relevant information and support on the part of physicians and other health professionals may be of particular use to this population segment.     

Smoking intensity, duration, and cessation, and the risk of rheumatoid arthritis in women

Background

Cigarette smoking has been associated with rheumatoid arthritis (RA), but the importance of smoking intensity, duration, and time since quitting, and whether the risk is primarily for rheumatoid factor (RF) seropositive versus seronegative RA are still unclear.

Methods

We conducted a prospective analysis of smoking and the risk of RA among 103,818 women in the Nurses’ Health Study. A total of 680 RA cases, diagnosed from 1976 and 2002, were confirmed using a questionnaire and medical record review. Sixty percent were RF positive. Cox proportional hazards models calculated the relative risks (RRs) of RA with smoking, adjusting for reproductive and lifestyle factors.

Results

The RR of RA was significantly elevated among current (RR 1.43 [95% confidence interval 1.16-1.75]) and past smokers (RR 1.47 [95% confidence interval 1.23-1.76]), compared with never smokers. The risk of RA was significantly elevated with 10 pack-years or more of smoking and increased linearly with increasing pack-years (P trend <.01). A greater number of daily cigarettes and longer duration of smoking were associated with increased risk. The effect of smoking was much stronger among RF-positive cases than among RF-negative cases. The risk remained elevated in past smokers until 20 years or more after cessation.

Conclusions

In this large cohort, past and current cigarette smoking were related to the development of RA, in particular seropositive RA. Both smoking intensity and duration were directly related to risk, with prolonged increased risk after cessation.