Tobacco use amongst high school students in the Czech Republic

OBJECTIVE: We were interested in the prevalence of smoking amongst teen-age students, its possible causes, and their understanding of its associated health risks. METHODS: We constructed a questionnaire that was responded to by a total of 419 students from 5 high schools in Prague, Czech Republic. Students were classified as non-smokers, mild (1-10 cigarettes daily), moderate (11-20 cigarettes daily), and severe smokers (>20 cigarettes daily). The survey also contained questions about passive smoking, motivation for smoking, the understanding of its associated health risks, alcohol consumption, and drugs. RESULTS: We found that amongst 16-20 years old high school students there are 37.5% smokers (38.0% men, and 37.0% women). The majority are mild smokers (82.3%), 15.8% moderate smokers and 1.9% heavy smokers. 29.0% of non-smokers reported passive smoking; i.e. that 65.7% of students are exposed to harmful effect of tobacco smoke. The average onset of smoking is at 14 years of age. The youngest smoker started smoking at the age of 5 years. Parents of 52.0% of students smoke (69.4% of smokers and 41.6% of non-smokers). Most of students know about the risk of lung cancer and cardiovascular diseases (86-99%). CONCLUSIONS: The prevalence of active and passive smoking among high school students is high. Parents smoking is significantly more frequent in teen-age smokers than in non-smokers. We consider the "teen-age" population together with their parents to be the key target for a successful antismoking campaign.     

Knowledge of health effects and intentions to quit among smokers in India: findings from the Tobacco Control Policy (TCP) India pilot survey

Awareness of the health risks of smoking is an important factor in predicting smoking-related behaviour; however, little is known about the knowledge of health risks in low-income countries such as India. The present study examined beliefs about the harms of smoking and the impact of health knowledge on intentions to quit among a sample of 249 current smokers in both urban and rural areas in two states (Maharashtra and Bihar) from the 2006 TCP India Pilot Survey, conducted by the ITC Project. The overall awareness among smokers in India of the specific health risks of smoking was very low compared to other ITC countries, and only 10% of respondents reported that they had plans to quit in the next six months. In addition, smokers with higher knowledge were significantly more likely to have plans to quit smoking. For example, 26.2% of respondents who believed that smoking cause CHD and only 5.5% who did not believe that smoking causes CHD had intentions to quit (χ2 = 16.348, p < 0.001). Important differences were also found according to socioeconomic factors and state: higher levels of knowledge were found in Maharashtra than in Bihar, in urban compared to rural areas, among males, and among smokers with higher education. These findings highlight the need to increase awareness about the health risks of smoking in India, particularly in rural areas, where levels of education and health knowledge are lower.     

Modified tobacco use and lifestyle change in risk-reducing beliefs about smoking

BACKGROUND: This study examined beliefs about potential risk-reduction strategies for tobacco users among a large group of young adults. Strategies examined included switching to low-yield cigarettes, replacing cigarettes with cigars, switching from cigarettes to smokeless tobacco, adopting a healthy diet, and engaging in regular exercise. METHODS: One-year longitudinal survey of 36,012 young adults (mean 20.1 years) entering the U.S. Air Force from October 1999 to September 2000. RESULTS: Smokers generally rated the strategies as providing more risk-reduction potential than never smokers or ex-smokers, although the group differences were small. Diet, exercise, and switching to low-yield cigarettes were rated as providing the most health benefits, regardless of smoking status. Smokers who had either changed their diet or exercise to lower their risks from smoking had significantly lower perceived personal risk of developing a tobacco-related disease than other smokers. Smokers who believed that switching to smokeless tobacco would lower the health risks associated with smoking were more likely, while smokers reporting switching to low-yield cigarettes were significant less likely, to quit during a 1-year follow-up period. CONCLUSIONS: Beliefs about the risk-reduction benefits of both changes in tobacco use and health behaviors may impact tobacco use attitudes and practices.     

The cardiovascular health of residents in selected metropolitan cities in China

BACKGROUND: To better understand the cardiovascular health and leisure-time physical activity of residents in major metropolitan cities in China, 2196 subjects (39.0 +/- 10.7 years) who lived in Beijing, Shanghai and Hong Kong were investigated. METHODS: During the months of January to June 2001, residents of the three cities who went through annual medical examinations at participating hospitals and exercise physiology laboratories were recruited as subjects, with a target of 800-900 subjects per city. Data on their behavior and health-related cardiovascular heart disease (CHD) risk factors were assessed. RESULTS AND CONCLUSIONS: It was found that over 80% of the subjects were sedentary (participating less than 90 min/week in leisure physical activity). The percentages of subjects having three or more cardiovascular heart disease risk factors were highest in Beijing (72.2%), followed by Shanghai (53.5%) and then Hong Kong (29.3%), suggesting that the cardiovascular health of Hong Kong residents was the best. It was noted that while all cities have similar health problems, there were significant differences in CHD risk factor due to geographical differences: Beijing residents smoked, drank, had high serum cholesterol and did not exercise; Shanghai residents had high blood pressure and drank; and Hong Kong residents were overweight and had lower HDL level. It was found that as subjects grew older, their cardiovascular health became worse. Gender differences were also observed-female subjects have generally fewer CHD risk factors and thus better health than male subjects. A model to examine the effects of age and behavior-related factors on health was developed for each city. Implications on planning strategies and primary prevention programs of CHD were discussed, in light of intervening identified risk factors.     

中老年男性吸烟状况与心血管疾病发生风险的关联性

  目的  探讨中老年男性吸烟状况与心血管疾病(cardiovascular disease,CVD)及其亚型发生风险的关联性。  方法  本研究选取东风-同济(Dongfeng-Tongji,DFTJ)队列中基线未患冠心病(coronary heart disease,CHD)、中风、癌症、严重心电图异常的13 940名男性为研究对象。研究对象均完成了基线调查,包括问卷调查、体格检查、生化指标检查和血液样本采集。采用Cox比例风险回归模型进行关联性分析,计算风险比(hazard ratio,HR)和95%置信区间(confidence intervals,CI)。  结果  多因素调整后,与从不吸烟者相比,现在吸烟者发生CVD、CHD和中风的风险增加,吸烟指数≥ 40包年者发生CVD、CHD和中风的风险HR值分别为1.49(95%CI:1.32~1.68,P_trend=0.001)、1.40(95%CI:1.22~1.62,P_trend=0.026)和1.59(95%CI:1.26~2.00,P_trend=0.029),开始吸烟年龄 < 20岁者发生CVD和CHD的风险HR值分别为1.29(95%CI:1.06~1.58,P_trend=0.007)和1.30(95%CI:1.03~1.64,P_trend=0.010);与现在吸烟者相比,戒烟时长≥ 10年者发生CVD和中风的风险显著降低,HR值分别为0.80(95%CI:0.71~0.91,P_trend=0.017)和0.65(95%CI:0.50~0.84,P_trend=0.207)。  结论  吸烟能增加CVD、CHD和中风的发生风险,且吸烟指数越大或开始吸烟年龄越小,CVD发生风险越高。戒烟可降低CVD和中风的发生风险。     

Passive smoking: an environmental health risk

The supposed health risks of passive smoking are leading to increasingly restrictive legislation on smoking. Tobacco smoke is undoubtedly irritating to the eyes, nose and throat of non-smokers, but politicians wanted more spectacular facts. There is some evidence of fatal consequences of passive smoking, particularly increases in lung cancer and heart-disease mortality among non-smokers exposed to tobacco smoke. Most studies compare the non-smoking partners of smokers and non-smokers. The observed relative risks are too small to be ascertained reliably. The more than twentyfold increased risk of lung cancer among smokers and the presence of tobacco-related metabolites in non-smokers' body fluids lend support to the hypothesis that passive smoking causes lung cancer. The less than twofold increased risk of heart disease among smokers and the documented social-risk factors cast doubt on the validity of the increased risk of heart disease in non-smokers, associated with having a smoking partner. The precautionary principle regulates potential environmental health hazards: the suspicion and the hazard must be sufficiently serious to take legislative action. There is ample evidence of tobacco smoke's carcinogenicity and the accumulated knowledge strongly suggests that the legal threshold of an acceptable environmental health risk has been exceeded.     

Coronary heart disease and cardiovascular risk factors among people aged 25–65 years,as seen in Romanian primary healthcare

Background: In Romania data on cardiovascular risk factors are sparse. Objective: To describe the prevalence and distribution of cardiovascular risk factors in a primary care setting in Romania. Methods: In a cross-sectional study, patients aged 25–65 years on the lists of four general practitioners in Iasi (Romania), selected by 1/5 systematic sampling, were invited for a cardiovascular risk evaluation (interview, physical examination, blood tests for cholesterol and glucose). Prevalence rates for coronary heart disease (CHD), diabetes (DM) and other risk factors were estimated, SCORE risk was determined, and treatment targets were evaluated. Results: The response rate was 79% (325 men, 476 women). Prevalence rates were: CHD 7.4%, DM 3.2%, hypercholesterolemia (>190 mg%) 47.2%, hypertension 23.7%, obesity 21.2%, and smoking 33.8%. In women, obesity and lack of physical exercise were more prevalent, whereas in men, higher rates were found for smoking and an unhealthy diet. The proportion of patients considered to be at high risk (CHD, DM or SCORE ≥ 5%) was 39.2%. Female patients failed to meet targets for systolic blood pressure, total cholesterol and glucose, whereas smoking cessation will be the greatest challenge for men. Conclusion: There were relevant gender differences in modifiable cardiovascular risk factors. Many patients failed to meet treatment targets.     

Pipe and cigar smoking and major cardiovascular events, cancer incidence and all-cause mortality in middle-aged British men

BACKGROUND: Pipe and cigar smoking are still regarded by many as less hazardous to health than cigarette smoking. METHODS: Prospective study of 7735 men aged 40-59 years drawn from general practices in 24 British towns with mean follow-up of 21.8 years. The outcome measures include major coronary heart disease (CHD) and stroke events, cancer incidence, and deaths from all causes. RESULTS: There were 1133 major CHD events and 440 stroke events, 919 new cancers and 1994 deaths from all causes in the 7121 men with no diagnosed CHD, stroke, diabetes, or cancer at screening. Compared with never smokers, pipe/cigar smokers (primary and secondary combined) showed significantly higher risk of major CHD events (relative risk [RR] = 1.69, 95% CI: 1.32, 2.14) and stroke events (RR = 1.62, 95% CI: 1.08, 2.41) and of cardiovascular, non-cardiovascular, and total mortality (RR = 1.49, 95% CI: 1.13, 1.96, RR = 1.40, 95% CI: 1.08, 1.83 and RR = 1.44, 95% CI: 1.19, 1.74, respectively), after adjustment for lifestyle and biological characteristics. They also showed a significantly higher incidence of smoking-related cancers (RR = 2.67, 95% CI: 1.70, 4.26), largely due to lung cancer (RR = 4.35, 95% CI: 2.05, 8.94). Overall, the effects in pipe/cigar smokers were intermediate between never-smokers and light cigarette smokers, although risks for lung cancer were similar to light cigarette smokers. CONCLUSION: Pipe and cigar smoking, whether primary or secondary, carries significant risk of smoking-related ill health.     

Relationship of smoking to absenteeism due to illness and injury in male workers]

The relationship between smoking and absenteeism due to illness and injury was studied in 21,924 male workers employed in the chemical fiber industry in Japan. Smokers had a significantly higher incidence of absence than non-smokers. The proportion of cases of absence in smokers was 30% higher and the number of days of absence was 28% greater than in non-smokers. Ex-smokers also had a significantly higher incidence of absence than non-smokers. In ex-smokers the proportion of cases of absence was 22% higher and the number of days of absence was 68% greater than in non-smokers. Although there was no significant difference between smokers and non-smokers in the number of days of absence attributed to cardiovascular or respiratory diseases, smokers were absent for about twice as many days as non-smokers for diseases of the digestive system. For ex-smokers the number of days of absence was 4.3 times higher for cardiovascular diseases, 1.5 times higher for respiratory diseases, and 2.9 times higher for digestive system diseases than in non-smokers. After correction for age, type of work, Body Mass Index, exercise, and drinking by multiple logistic analysis significantly elevated relative risks for absence persisted both in smokers and ex-smokers vs. non-smokers at 1.4 and 1.3, respectively. Significant dose-response relationships between incidence of absence and the number of cigarettes smoked per day were observed in respiratory disease, diseases of the digestive system and all disease causes. A significant dose-response relationship between incidence of absence and smoking index was also observed for diseases of the digestive system. These findings clearly indicate that smoking by workers was associated with absence due to illness and injury, and suggest that smoking was a factor contributing to an increase in absenteeism due to illness and injury in workers.     

The effect of physician office visits on CHD risk factor modification as part of a worksite cholesterol screening program

BACKGROUND: Elevated serum cholesterol is a major risk factor for CHD. Primary prevention through behavioral modification has been designated first-line treatment for patients with elevated cholesterol. In this study, we assessed the impact of a physician office visit after a worksite cholesterol screening on self-reported changes in diet, weight loss, exercise, and smoking. We hypothesized that those individuals who had a physician office visit regarding cholesterol would make more changes in CHD risk factors than those who did not have such a visit. METHODS: A cohort of 4,928 participants from 33 work-sites in Massachusetts and Rhode Island had baseline CHD risk factors evaluated at a cholesterol screening and 4,473 were available at follow-up 6 months later by telephone interview. A total of 1,957 had elevated cholesterol levels (>/=200 mg;/dl) and were instructed to visit their physician, in addition to receiving educational materials related to CHD risk factor modification. RESULTS: Most individuals with elevated cholesterol levels had other prevalent self-reported CHD risk factors at baseline: 58% consumed high-fat diets (>30% fat), 43% were overweight, 60% had a sedentary lifestyle (sweat-related physical activity <3 x per week), and 22% were cigarette smokers. After 6 months of follow-up, 74% of participants with high-fat diets reported eating a lower fat diet, 71% of overweight participants reported weight loss, 53% of sedentary participants attempted to increase physical activity, and 38% of smokers decreased or quit cigarette smoking. Thirty-five percent of participants completed the referral for a physician office visit to discuss their elevated cholesterol determined at the baseline worksite screening. However, these individuals showed only a modest change (which was not statistically significant) in self-reported CHD risk factors compared with those who did not have follow-up physician visits after adjusting for age, sex, race, education, occupation, medical insurance, time since last doctor visit, diabetes, and hypertension. Objective measurements of serum cholesterol, body mass index, and dietary score were likewise modestly improved and not statistically significant. CONCLUSIONS: In 6 months of follow-up, high absolute levels of CHD risk factor modification were observed after a worksite cholesterol screening. A physician office visit added only a modest but not statistically significant benefit for further CHD risk factor modification. These findings indicate that the follow-up cholesterol-related physician visit had little added clinical benefit over the screening intervention alone.     

Perceived risks and reasons to smoke cigarettes during pregnancy among Alaska native women

Objective: The purpose of this study was to explore perceptions of the risks of smoking and reasons Alaska Native women give for smoking during pregnancy.

Design: A total of 118 women (54 smokers, 64 non-smokers) enrolled in a biomarker study and completed a baseline interview asking about their concerns regarding tobacco use while pregnant and reasons why pregnant women might smoke during pregnancy. Responses were collapsed into six categories of perceived risks of smoking and eight categories of reasons to smoke during pregnancy.

Results: The majority of both pregnant non-smokers and smokers (72.6% and 60.4%) agreed that smoking during pregnancy could negatively impact the health of their baby. However, non-smokers were more likely than smokers (77.4% vs. 58.5%) to view smoking during pregnancy as a risk factor for the baby’s development (p?=?.029). Both non-smokers and smokers identified addiction as a reason for smoking during pregnancy (82.8% and 63%); however, non-smokers were more likely than smokers to state this was a reason for use (p?=?.015). Seventy-three percent of the entire sample reported a reason to smoke in pregnancy was to help manage negative affect.

Conclusion: Results from this work may be helpful in advancing research by identifying targets for intervention specific to Alaska Native women receiving prenatal care in Anchorage, Alaska.     

海口市≥40岁健康体检人群心血管疾病危险因素分布

目的 了解海口市≥40岁健康体检人群心血管疾病危险因素分布特点,为该地区心血管疾病防治工作提供参考依据。方法 2021年3—6月在海口市某医院对进行健康体检的海口市≥40岁人群调查其人口学特征以及心血管病高危因素（血压升高、总胆固醇升高、血糖升高、超重或肥胖、吸烟、饮酒、不健康膳食、缺乏体育锻炼）,分析心血管疾病危险因素分布特点。结果 纳入1 319名≥40岁健康体检人群,男性692名,女性627名。检出具有心血管疾病高危因素人群673例,检出率为51.02%。其中检出1种高危因素者469例（69.69%）,检出2种高危因素者119例（17.68%）,检出≥3种高危因素者85例（12.63%）。男性、70~78岁、居住地为村镇、初中及以下学历、无业或退休人员具有心血管疾病高危因素的比例更高（P<0.05或P<0.01）。血压升高者97例（14.41%）,总胆固醇升高92例（13.67%）,血糖升高82例（12.18%）,超重或肥胖120例（17.83%）,吸烟136例（20.21%）,饮酒158例（23.48%）,不健康膳食109例（16.20%）,缺乏体育锻炼197例（29.27%）。结论 海口市≥40岁健康体检人群心血管疾病危险因素广泛流行,部分人群不同危险因素共同存在。     

Pleasure or pain? A profile of smokers in Northern England

OBJECTIVE: To construct a profile of smokers using multiple indices of physical, mental and social health. STUDY DESIGN: Cross-sectional study. METHODS: The setting was Wigan and Bolton Health Authority, an urban district in the North West of England. A random sample of over 15000 adults from the Health Authority adult population completed a written questionnaire. Prevalence ratios were calculated for physical, mental and social health indicators for smokers compared with non-smokers, adjusted for borough, age and deprivation score of place of residence. RESULTS: Smokers were less likely to report their current health as good, and reported a significantly higher prevalence of arthritis, bronchitis, backache and respiratory symptoms. Smokers had more mobility problems and recent severe pain. Smokers had less healthy lifestyles across many behaviours (e.g. poorer diet, taking less regular exercise and more problem drinking). Depression and the proportion of people with a high psychiatric morbidity score were increased. More women smokers reported a lack of social support, and smokers more often reported financial difficulties. Differences were exaggerated by comparing heavy smokers with non-smokers. CONCLUSIONS: Independent of the level of deprivation of their area of residence, smokers have poorer physical, social and mental health, with a dose-response effect. Smoking creates considerable pain, but little evidence of pleasure.     

Coronary heart disease risk factors: prevalence and behavior among male university students in Dammam City, Saudi Arabia

Smoking, hypertension, and diabetes mellitus are the common risk factors among patients with coronary heart disease (CHD). High dietary fat intake, smoking, and lack of physical exercise have all been documented as independent risk factors for the development of CHD. The aim of the present study was to determine the prevalence of CHD risk factors among King Faisal University (KFU) male students in Dammam city, Saudi Arabia. A sample size of 10% of the target population (2054 male students of KFU colleges) was selected comprising 205 students. The study sample was selected by a multistage stratified random sampling technique with proportional allocation from all class levels. The response rate was 77.6%, where a total of 159 students were included in the study. Data was collected using an interviewer-administered questionnaire, which included sociodemographic variables and risk factors for CHD. The following measurements were performed: weight, height, body mass index (BMI), waist-to-hip ratio (WHR), blood pressure, and random capillary blood glucose. It was found that 28.9% of the university students do not practice any type of physical exercise. About 19% of the students were current smokers. A high proportion of university students were consuming fast foods, saturated fats, and soft drinks. Overweight (24.5%), obesity (11.9%), severe obesity (10.7%) as measured by BMI, as well as unacceptable WHR (10.7%) as an indicator of obesity were evident. Family history of obesity and unacceptable WHR were found to be statistically associated with increased obesity. Therefore, intervention programs to raise the health awareness of adolescents about CHD risk factors and encourage them to adopt a healthy dietary behavior, promote physical exercise and smoking cessation should be initiated.     

How to identify gene-environment interactions in a multifactorial disease: CHD as an example

CHD is a multifactorial disease, caused by both genetic and environmental factors. The inherited 'defective' genes will vary from individual to individual, and any single mutation is likely to be making only a small contribution to risk. The context dependency, i.e. the importance of environmental factors in influencing genetic risk, is now becoming evident. Thus, a mutation may have a modest effect on risk in individuals who maintain a low environmental risk, but a major effect in a high-risk environment. Methods of analysing gene-environment interactions on CHD risk will be discussed and illustrated with several examples. APOE has three common alleles, epsilon2, epsilon3 and epsilon4. The epsilon4 allele has consistently been associated with CHD risk, which has been confirmed by meta-analysis. However, when the effect of genotype on risk was considered in smokers and non-smokers separately, risk in non-smokers was similar in all APOE genotypes. By comparison, in the smokers, epsilon3 homozygotes, as expected, had an approximately 2-fold higher risk, while for epsilon4 carriers there was a significantly greater than additive effect of genotype and smoking on risk (P<0.007). Thus, the impact of the epsilon4 allele on CHD risk appears to be confined to current smokers, an effect that has been confirmed in several studies. Another example is the interaction between the alcohol dehydrogenase 3 gene variant and alcohol consumption on CHD risk (P<0.001), showing the context dependency of the effect. Thus, the importance of considering environmental factors as potential genotype-risk modifiers has major public health implications.     

Cognitive–Behavioral Mediators of Changing Multiple Behaviors: Smoking and a Sedentary Lifestyle

Background.A significant percentage of the U.S. population has multiple poor health behaviors. Understanding the relationship among these behavioral risk factors is important for designing effective multiple risk factor interventions. While there is some evidence suggesting that participation in physical exercise may have a positive impact on smoking cessation, there is much to be learned about the relationships between cognitive–behavioral (self-efficacy, decisional-balance) and motivational mechanisms (stage of change) which have been shown to mediate changes in both exercise and smoking behavior.Methods.The sample comprised 332 smokers employed at two workplaces—a government agency and a medical center—recruited as part of a larger worksite health promotion project and who completed questionnaires on their smoking and exercise behaviors.Results.The results revealed significant relationships between smoking variables and exercise variables. Smokers who rated as important the positive benefits of smoking also rated as important the costs associated with increased physical activity. Similarly, the negative consequences of smoking were significantly associated with the positive benefits of physical activity. Self-efficacy for one behavior was significantly associated with self-efficacy for the other. Significant differences by exercise and smoking stage of change were found on the cross-behavior sets of variables (self-efficacy, pros, cons). Smokers who were contemplating a more active lifestyle reported the negative consequences of smoking to be significantly more important to them than smokers who were not considering adoption of a more active lifestyle. Smokers who were exercising regularly reported significantly more confidence in their ability to refrain from smoking than smokers not exercising regularly. Finally, smokers preparing for quitting reported less confidence in their ability to exercise than smokers who had already taken action to change their smoking behavior.Conclusions.The cognitive mechanisms associated with changes in smoking behavior are related to the cognitive variables which have been shown to predict changes in exercise behavior. Significant relationships in mediating mechanisms including decisional balance and self-efficacy between smoking and exercise provide preliminary information on how change in one risk behavior may relate to change in another. These associations have implications for future intervention research and for methods research on multiple risk factor interactions.     

Sexual differences in smoking behaviour and dental caries experience in young adults

Smokers have been reported to exhibit a low awareness of their health. However, oral health awareness in smokers has not been fully studied. Having adequate oral care and high awareness of oral health from youth is necessary to prevent the deterioration of oral health in middle and old age. The aim of this study was to investigate the oral health status and oral health behaviour in young smokers. A survey composed of a questionnaire and an oral examination was administrated to adults aged 20-29 y who consulted dentists. The relationship between smoking behaviour and oral health status and oral health behaviour in subjects was analysed. In women, though no significant relationship between smoking behaviour and the number of decayed, missing, and filled teeth was seen, current smokers had significantly more decayed teeth, missing teeth and fewer filled teeth than ex-smokers and non-smokers. Current smokers tended to practice less oral health behaviour than non-smokers. In men, there was no significant relationship between smoking behaviour and each oral health status item. These findings suggested that the smoking group had lower oral health awareness than the non-smoking group in women.     

Tobacco and alcohol consumption: impact on other cardiovascular and cancer risk factors in a southern European Mediterranean population

Tobacco and alcohol consumption are strongly related to other cardiovascular and cancer risk factors. The aim of the present study was to analyse the association of nutrient intake, blood lipid variables and leisure-time physical activity with tobacco and alcohol consumption status. Participants were recruited in a cross-sectional population-based survey, including cardiovascular risk factor measurements and evaluation of physical activity and diet intake in a Mediterranean population (n 1748). Multiple linear regression analysis, adjusted for several confounders, showed a direct association of saturated fatty acids (g and % total energy intake), dietary cholesterol intakes and serum triacylglycerol with smoking. An inverse association was observed for smoking and unsaturated fatty acids (% energy intake), vitamin C, alpha-tocopherol and beta-carotene intakes, leisure-time physical activity and HDL-cholesterol. These associations were not observed for alcohol drinking. After adjusting for the confounders earlier mentioned, low dietary intakes of vitamin C and dietary fibre were more likely in heavy-smokers as compared with non-smokers (odds ratio 1.74 (95 % CI 1.07, 2.73) and 1.94 (95 % CI 1.29, 2.92) of low vitamin C (<60 mg/d) and dietary fibre intakes (<10 g/d) respectively). Alcohol consumption was directly associated with HDL-cholesterol and triacylglycerol, and attenuated the effects of smoking on HDL-cholesterol. These results suggest that the dietary intake of fibre and several antioxidant components of the Mediterranean diet is reduced in smokers, who also show an adverse lipid profile. However, the worst triacylglycerol levels are associated with the combination of heavy smoking and heavy alcohol drinking. Moderate alcohol consumption was not associated with an unhealthy diet pattern or adverse lipid profile. The health benefits of the Mediterranean diet appear to be strongly counteracted by smoking.     

肺癌危险因素及交互作用研究

目的探讨肺癌的影响因素及其交互作用。方法采用病例对照研究设计,收集781例肺癌病例,并按性别、年龄(±3岁)进行1:1匹配,通过调查问卷获取生活饮食习惯等信息。构建决策树及非条件Logistic回归模型,计算OR值及其95%CI,分析影响因素间的交互作用。结果肺癌的危险因素有吸烟(轻度吸烟OR=1.67,重度吸烟OR=7.27)、被动吸烟(轻度被动吸烟OR=2.63,重度被动吸烟OR=6.25)、居住地污染(吸烟者OR=2.26,不吸烟者OR=1.72)、肺癌家族史(吸烟者OR=15.94);保护因素有常吃水果(吸烟者OR=0.69,不吸烟者OR=0.44)、锻炼(吸烟者OR=0.50)、饮茶(不吸烟者OR=0.57)。吸烟与居住地污染、肺癌家族史存在交互作用,重度吸烟与不锻炼存在交互作用。结论吸烟、被动吸烟、居住地污染、肺癌家族史可增加肺癌风险,常吃水果、锻炼、饮茶有助于预防肺癌。肺癌影响因素间的协同作用应予重视。     

Smoking status and dietary fats.

BACKGROUND. There have been several recent reports of differences in the diet of smokers versus that of nonsmokers. This has broad implications for assessment of disease risk associated with diet or smoking. METHODS. We examined dietary fats for several categories of smoking status in a large cross-sectional data set. The annual risk factor survey of a cardiovascular disease prevention trial in three pairs of upper Midwest communities includes 3,495 subjects ranging in age from 24 to 75. Smoking was assessed by self-report and thiocyanate, and diet by the Willett questionnaire. Dietary comparisons of smokers, recent quitters, long-term (over 1 year) quitters, and never-smokers were conducted. RESULTS. Previous findings of lower polyunsaturated fat intake in smokers were confirmed and extended by finding significantly elevated polyunsaturate intake among those who had quit smoking within the last year. The source of these differences is unclear, but the differences are large enough to constitute a significant contribution to disease risk for smokers or a protective effect for recent quitters. CONCLUSIONS. Future research examining risks associated with smoking or diet should control for the interaction of the two factors. The dietary differences in recent quitters, whether caused by a conscious decision to improve diet, a change in taste perception as a result of quitting, or simply the habits of those smokers who are able to quit, need further exploration.