The prevalence of smoking and its relationship to other coronary risk factors in a rural white community

A cross-sectional study of tobacco-smoking habits and its relationship to other coronary risk factors in a large rural community of 7,188 white subjects aged 15-64 years, revealed that 48.1% of the men and 17.9% of the women were currently smoking; only 28.6% men and 74.1% women had never smoked. Heavy smoking prevailed, with a mean daily consumption of 21.4 g and 14.6 g tobacco among male and female smokers respectively. Only 16.5% of male and 27.7% of female smokers smoked less than 10 g tobacco per day. Smoking was associated with a high total cholesterol level, a low high-density lipoprotein cholesterol level, low blood pressure, a low body mass index, coronary-prone type A behaviour, and a high prevalence of coronary heart disease in men. Furthermore, smoking was associated with a high alcohol consumption and a low level of education and occupational class. These findings emphasise the high prevalence of smoking in whites and its harmful association with coronary heart disease, and indicate the need for effective anti-smoking programmes.     

Prevalence of chronic cough and phlegm among male cigar and pipe smokers: results of the Scottish Heart Health Study.

BACKGROUND--Previous studies investigating the effect of cigar or pipe smoking on the occurrence of chronic cough and chronic phlegm have reported prevalences among cigar and pipe smokers lying between those of non-smokers and current cigarette smokers. This study uses data on previous cigarette consumption, current cigar or pipe consumption, and biochemical markers of smoking to provide a detailed analysis of chronic cough and chronic phlegm among cigar and pipe smokers. METHODS--A total of 10,359 men and women aged 40-59 years were sampled for the Scottish Heart Health Study between 1984 and 1986. Prevalence of chronic cough and chronic phlegm among male cigar and pipe smokers (non-cigarette smokers) was compared with those who had never smoked, between ex-smokers of cigarettes and those who had never smoked cigarettes, between cigar-only and pipe-only smokers, and by cigar or pipe consumption levels. RESULTS--In all, 463 ex-smokers of cigarettes and 154 who had never smoked cigarettes were cigar or pipe smokers; 1080 had never smoked any form of tobacco. Ex-cigarette smokers smoked and inhaled more than those who had never smoked cigarettes. Among the ex-cigarette smokers, cigar or pipe smokers had 1.63-1.71 times the prevalence of both chronic cough and chronic phlegm than those who had never smoked (1.31-1.36 among cigar only smokers; 2.23-2.84 among pipe only smokers). A strong positive dose-response effect was found between the prevalence of symptoms and cigar or pipe consumption. CONCLUSIONS--Cigar and pipe smokers have a higher prevalence of chronic cough and phlegm than those who have never smoked, and the difference is more marked in pipe-only smokers than in cigar-only smokers. Both categories show a positive dose-response effect. Among cigar and pipe smokers, ex-cigarette smokers have a higher prevalence of symptoms than those who have never smoked cigarettes, which may be because they inhale more or may be attributable to previous cigarette smoking.     

Male cigarette smoking and fecundity in couples attending an infertility clinic

The relationship between male cigarette smoking and fertility was studied for 330 couples attending an infertility clinic. 59% did not smoke, 10% smoked between 1 and 5 per day, 8% smoked between 6 and 10 per day, 16% smoked 11-20 per day and 7% smoked more than 20 per day. There was no significant association between smoking and any semen parameter. 138 men had a female partner who was apparently normal. There was no significant difference in smoking habits between the 'normal' and 'abnormal' female groups. Couples were followed-up for up to 32 months. Nineteen women had a treatment independent conception within the 'normal' female group. There was no significant association between the number of cigarettes smoked and the fertility outcome.     

Relationship between type of tobacco used and localization of tumour in patients with gastric cancer.

The relationship between the type of tobacco used and the localization of the tumour was studied in 493 patients with gastric cancer. The relative frequency of tumour site was found to vary significantly with the type of tobacco. In men who used all kinds of tobacco, a pipe was the most common form of smoking. Women smoked only cheroots or cigarettes or both. Male smokers showed a significantly higher percentage of tumours at the cardia than did female smokers. Female smokers had a significantly higher percentage of tumours involving the entire stomach than male smokers. Male smokers with tumours at the cardia were significantly more often pipe smokers and cigarette smokers than cheroot smokers. Male smokers with tumours involving the entire stomach were significantly more often cheroot smokers than cigarette smokers. The localization of tumours in cigarette smokers differed in men and women, indicating that cigarette smoking per se possibly plays a subordinate causal role. On the other hand, the distribution pattern of the localization among cheroot smokers was practically the same in both sexes, which might indicate that this type of smoking plays an important role. The same probably applies to pipe smoking, especially when combined with snuff or chewing tobacco, but these types of tobacco had not been used by the women. It is mentioned that not only the nature of tobacco used, but also concurrent factors may influence the localization of the tumours.     

The association between cigarette smoking and back pain in adults.

STUDY DESIGN: A retrospective cohort study of adolescent idiopathic scoliosis. A comparison group of persons without scoliosis was also selected randomly from the general population. OBJECTIVES: To estimate the association between level of cigarette smoking and the prevalence and severity of back pain. METHODS: A postal questionnaire was used to elicit information on smoking histories, a variety of indices of low back pain, and potential confounding factors. The association between smoking and back pain was estimated separately for men and women in the cohort and in the comparison group using ordinal regression models. RESULTS: The questionnaire was completed by 1287 women and 184 men who had adolescent idiopathic scoliosis and by 1130 women and 621 men in the comparison population who did not have scoliosis. Statistically significant associations between back pain and current cigarette smoking were found in the two groups of women and men with scoliosis, but not among men selected from the general population. In the three former groups, proportional odds ratios comparing current smokers to persons who never smoked ranged from 1.4 to 1.9. Among current smokers, the prevalence of back pain increased with cigarette consumption, and the proportional odds ratios ranged from 1.2 to 1.8 per 10 pack-years (no. of cigarettes smoked per day x no. of years/20). In these three groups, intensity, frequency, and duration of episodes of back pain also were found to increase with smoking consumption. CONCLUSION: The finding that smokers have more frequent episodes of back pain may imply that smoking exacerbates back pain, and the observation that stronger associations between back pain and smoking were found in the scoliosis cohort suggests that smoking may have a greater impact on persons with damaged spines.     

Decline of the lung function related to the type of tobacco smoked and inhalation.

Data from a five year follow up study on 4372 smokers and 3753 non-smokers were analysed to investigate the influence of the type of tobacco smoked and whether the subjects said they inhaled or not on the decline in forced expiratory volume in one second (FEV1). The study sample comprised 1492 smokers of plain cigarettes and 1936 smokers of filter cigarettes, 1711 smokers of cheroots or cigars, and 233 male pipe smokers. Over the five years, smokers, especially those who said that they inhaled, had a higher rate of decline of FEV1 than non-smokers, in whom the average decline in FEV1 was 25 ml/year for women and 30 ml/year for men. There was no significant difference in the decline in FEV1 between filter cigarette smokers and plain cigarette smokers. The decline in FEV1 in cigar or cheroot smokers was the highest for all the smoking groups, and associated with a very high tobacco consumption in this group. Among pipe smokers who inhaled, the decline in FEV1 was slightly higher than in the cigarette smokers, whereas non-inhaling pipe smokers had a decline in FEV1 that was similar to that of non-smokers. In general, the smokers who said that they did not inhale had a smaller decline in FEV1 than those who said that they did. The effect of inhalation varied in magnitude in different smoking groups, being most pronounced in pipe smokers.     

Adverse Effects of Smoking on Peak Bone Mass May Be Attenuated by Higher Body Mass Index in Young Female Smokers

Smoking is associated with postmenopausal bone loss and fracture, but the effect of smoking on bone in younger women is unclear. Peak bone mass is an important determinant for fracture risk; therefore, our aim was to evaluate the association between smoking and bone mass in 25-year-old women, specifically the influence of daily cigarette consumption and total exposure, duration, age at starting smoking, and time since smoking cessation on bone density and fracture risk. Smoking and bone mineral density (BMD) data were available for 1,054 women from the PEAK-25 cohort. Analyses comparing current smokers with women who never smoked were performed using number of cigarettes per day, pack-years, smoking duration, age smoking started, and, for former smokers, age at quitting. BMD did not differ between never, former, and current smokers; and the relative fracture risk in smokers was not significant (relative risk [RR] = 1.2, 95 % confidence interval 0.8–1.9). Among current smokers, BMD decreased with a dose response as cigarette consumption increased (femoral neck p = 0.037). BMD was not significantly lower in young women who had smoked for long duration or started smoking early (p = 0.07–0.64); long duration and early start were associated with higher body mass index (BMI; p = 0.038). Lower BMD persisted up to 24 months after smoking cessation (p = 0.027–0.050), becoming comparable to never-smokers after 24 months. Hip BMD was negatively associated with smoking and dose-dependent on cigarette consumption. Smoking duration was not associated with BMD, although young women with a long smoking history had higher BMI, which might attenuate the adverse effects from smoking.     

Smoking practices in the black township population of Cape Town

A smoking prevalence survey was conducted in the black township population of Cape Town in order to assist with the planning of an anti-smoking campaign. Three townships were selected to reflect different levels of urbanisation: Langa (a settled urban community), Site B (a population of recent arrivals in the urban environment) and Khayelitsha (of intermediate urban status). Using World Health Organisation guidelines a school survey and an adult survey were conducted in each area. Of the 673 school pupils who were interviewed, 0.8% of girls and 23.7% of boys were current smokers. There was a trend to increasing smoking prevalence with increasing age among boys. After age-adjustment there was no difference in smoking prevalence between boys at the three schools. Information from 1320 adult respondents and 1,401 proxy-reported adults yielded an overall smoking prevalence of 7% (95% confidence interval 5.6-8.4%) for women and 60% (95% confidence intervals 57.5-62.5%) for men. Two-thirds of male smokers were smoking 10 or more cigarettes per day. The preferred mode of tobacco consumption in 87% of adults and 91% of school pupils was manufactured cigarettes. The survey has established three target groups for intervention in the black townships of Cape Town: boys in their early teens for prevention of initiation of smoking; adult men for assistance with smoking cessation; and girls and women to maintain their non-smoking status.     

Health actions and disease patterns related to coronary heart disease in the coloured population of the Cape Peninsula

The health-related behaviour of the Cape Peninsula coloured population, which has been shown to have an adverse coronary heart disease (CHD) risk factor profile, is reported. Private medical services were used most often by participants: 54.1% and 51.6% of males and females respectively had made use of these services during the preceding year. Only 17.9% and 21.8% of males and females respectively had attended day hospitals during the year. Blood pressures were measured in 43.8% and 57.1% of male and female participants respectively during the year preceding the study. The results indicated the need for the measurement of blood pressure to determine the true prevalence of hypertension, since patient reporting of the condition was inaccurate. Attempts to give up smoking had been made by 44.4% of male and 47.1% of female smokers. About 75% of the participants were found to have hypercholesterolaemia, yet their knowledge of the prudent diet was poor and few reported appropriate dietary modifications to protect against CHD. Frequent reporting of hypercholesterolaemia, hypertension and constipation by the study population highlights the need for dietary education. Mortality rates (MRs) for CHD and cerebrovascular disease (CVD) for the coloured and the white populations were compared. In all age groups white males had higher MRs for CHD than coloured males, while coloured females older than 34 years had higher rates than their white counterparts. The coloured population had MRs for CVD that were higher than those of whites.     

Effects of current smoking and smoking discontinuation on renal function and proteinuria in the general population

BACKGROUND: Smoking may adversely affect the progression of renal diseases. However, it is unknown whether smoking affects renal function in subjects without nephropathy. METHODS: In 1998, 28,409 volunteers from the general population were examined at the Institut Régional pour la Santé (IRSA). Renal function was estimated with creatinine clearance using the Cockcroft formula. Dipstick proteinuria was assessed on an overnight urine sample by a trained technician. RESULTS: Adjusted creatinine clearance was higher in current smokers than in former smokers and never smokers (100.6 +/- 13.6 vs. 98.8 +/- 13.9 mL/min/1.73 m2, P < 0.0001, and vs. 98.5 +/- 14.0 mL/min/1. 73 m2, P < 0.0001, respectively). This difference was predominant in men and weak in women, and was associated with the number of cigarettes smoked daily. The slope of the projected age-related decline in the creatinine clearance accelerated with age, but it was similar in current smokers, former smokers, and never smokers. Creatinine clearance was associated with a relative risk of proteinuria [for each mL/min/1.73 m2, the relative risk was 1.007 (95% CI, 1.000 to 1.015), P = 0.056, for 1+ or higher proteinuria; and 1.018 (1.004 to 1.030), P = 0.0078, for 2+ or higher proteinuria]. Current and former smokers had a marked risk of 2 or higher proteinuria [adjusted RR (95% CI), 3.26 (1.66 to 6.80), P = 0. 0009, and 2.69 (1.24 to 5.99), respectively, P = 0.013, vs. never smoking], which was independent of the daily or cumulative cigarette consumption. CONCLUSIONS: In the general population, smokers do not exhibit lower creatinine clearance than never smokers. In fact, creatinine clearance is slightly higher in current smokers at least in men, even when normotensive and hypertensive subjects are analyzed separately, but the difference is small, especially in women. This effect seems reversible upon smoking discontinuation. Chronic smoking results in a marked risk of irreversible proteinuria that may occur despite moderate smoking.     

Endogenous testosterone levels and smoking in men. The fifth Tromsø study

Smoking is a risk factor of coronary heart disease (CHD), while the role of testosterone in the development of CHD is controversial. The reported effects of cigarette smoking on testosterone levels in men are conflicting, and smoking may be an important confounding factor when evaluating the relationship between testosterone levels and CHD. Thus, the objective of the present study was to examine the associations of smoking status and number of cigarettes smoked per day with total and free testosterone levels in a cross-sectional population-based study of 3427 men participating in the fifth Troms? study. Total testosterone, luteinizing hormone, follicle-stimulating hormone and sex hormone-binding globulin levels were measured with immunoassay while free testosterone levels were calculated. Waist circumference was also measured and two standardized questionnaires were completed, including smoking status and number of cigarettes smoked. The data were analysed with analysis of variance and covariance and multiple regression analysis. Smoking men had significantly higher levels of total and free testosterone compared with men who never smoked (p < 0.001 and <0.01 respectively). Both total and free testosterone levels increased significantly with increasing number of cigarettes smoked daily (p < 0.001). Smoking men had 15% higher total and 13% higher free testosterone levels compared with men who never smoked. Thus, smoking seems to be an important confounding factor when evaluating testosterone levels, and could possibly mask borderline hypogonadism.     

A simple, inexpensive urine test of smoking

Three novel colorimetric methods of detecting urinary nicotine metabolites called the barbituric acid, diethylthiobarbituric acid (DETB), and DETB extraction methods were evaluated for use as a simple, cheap, objective test of smoking. Urine samples were collected from 103 male smokers and 78 male non-smokers working at two London factories. The smokers recorded the number of cigarettes smoked over the previous 36 hours. All three methods correctly classified the smokers. The DETB extraction method had a lower false positive rate (averaging 3% on morning and afternoon urine samples) than either the DETB or the barbituric acid method (12% and 6% respectively) and was the best procedure for classifying subjects as "smokers" or "non-smokers." When a quantitative variant of the barbituric acid method was used there was a significant correlation (r = 0.85, p less than 0.001) between the ratios of urinary nicotine metabolites to creatinine and the number of cigarettes smoked. The ratios for smokers of 6-15, 16-25, and 26 or more cigarettes, however, overlapped considerably. The methods can be performed very rapidly and the reagent cost is equivalent to less than 1p per test.     

Nocturnal penile tumescence in cigarette smokers with erectile dysfunction.

We examined the relationship between cigarette smoking and erectile physiology in 314 men with erectile dysfunction. All of the men studied were currently cigarette smokers. Evaluations included interviews, physical examinations, and polysomnographic assessment of sleep-related erections. Penile rigidity during nocturnal erection inversely correlated with the number of cigarettes smoked per day. Smoking was also associated with indices of impairment on autonomic function tests and some measures of penile blood pressure. The group of men who smoked the most (more than 40 cigarettes per day) had the fewest minutes of nocturnal tumescence and detumesced fastest. These data are discussed with respect to the results of studies performed in dogs that demonstrated smoking-related reduction in arterial flow and venous restriction. Our findings suggest that smoking may further compromise penile physiology in men experiencing difficulty in maintaining erections long enough for satisfactory intercourse.     

Smoking as a risk factor for erectile dysfunction: data from the Andrology Prevention Weeks 2001-2002 a study of the Italian Society of Andrology (s.I.a.)

OBJECTIVE: To analyse the relationship between smoking and erectile dysfunction (ED). METHODS: To provide further data on this issue, we analysed information gathered from men attending a free andrologic consultation in 234 Italian medical centres, in the setting of a project focused on andrologic prevention. Men were asked about "their ability to achieve and maintain an erection sufficient for satisfactory sexual performance". If they were dissatisfied, they were defined as having ED. RESULTS: Out of 16724 subjects, ED was diagnosed in 4081 men (24.4%). After adjustment for age, marital status, education, alcohol consumption, physical activity and concomitant pathologies, in comparison with never smokers, men who currently smoked more than 10 cigarettes/day and former smokers showed significantly higher odds ratio (ORs 1.4 and 1.3, respectively) for ED. These results were confirmed performing analysis in strata of diabetes, hypertension, cardiovascular disease and hypercolesterolemia. COMMENTS: This transversal observational study shows that the risk of ED is influenced by smoking. A dose- and duration-response effect is present; changes in smoking habits do not seem to significantly affect the risk to develop ED.     

Lung cancer in a defined geographical area: history and histological types.

Lung cancer was diagnosed in 446 patients during four years in a population living in a defined geographical area in northern Finland. The series comprised 420 men and 26 women, with a male/female ratio of 16.6:1. The diagnosis was confirmed histologically or cytologically in 431 cases (97%). Epidermoid carcinoma was the most common histological type of tumour in the men, followed by small cell anaplastic and adenocarcinoma, whereas in the women all these types were of equal frequency. Almost all the men, but only about half of the women, were smokers or ex-smokers. The amount smoked daily had no correlation with the histological type of cancer, whereas those patients who had started smoking early had relatively more Kreyberg group I tumours (epidermoid, small cell, and large cell carcinoma) than those who had started smoking late. Cancer was usually detected on the basis of symptoms, but 17% emerged from mass radiography or some health examination, and 12% from examinations for another disease. Fifteen per cent of the patients had no symptoms at the time of diagnosis, this being more common among the patients with epidermoid or adenocarcinoma than among those with anaplastic forms.     

Smoking and sexual dysfunction in Chinese males: findings from men's health survey

To describe the prevalence of erectile dysfunction (ED) and its association with smoking among the Chinese in Hong Kong, we conducted a cross-sectional study among 819 men (aged 31-60 years) who were randomly selected among the Hong Kong residents and interviewed by trained interviewers. A structured questionnaire was used for data collection. We found that current smokers who smoked 20 cigarettes or more daily had more dissatisfaction, erection difficulty and ED than never smokers. The prevalence of dissatisfaction, difficulty in erection and ED increased significantly (P<0.05) with increasing age. Compared with never-smokers, current smokers of more than 20 cigarettes daily had a greater risk of ED (age-adjusted odds ratio=1.47, 95% confidence interval: 1.00-2.16). Our results support that there are association between ED and smoking among the Chinese and suggest linking ED with smoking in the antismoking campaign and promoting smoking cessation to reduce ED among smokers.     

Physiological evidence that emphysema is not a feature of byssinosis.

A group of women with byssinosis of grades 2 and 3 were seen consecutively over three years in an occupational outpatient clinic. Detailed lung function tests were performed and the results for smokers and non-smokers compared. One hundred and fifty three patients were seen and 50 of these were life time non-smokers, 35 smoked one to nine cigarettes a day, and 68 smoked 10 or more cigarettes a day. After correction for age the mean FEV1 was found to be significantly lower (p less than 0.01) in heavy smokers than in non-smokers. In a subgroup of 89 subjects who were able to perform the carbon monoxide gas transfer test significantly lower values were obtained for the carbon monoxide transfer factor (TLCO), (p less than 0.001), TLCO % predicted (p less than 0.001), and the transfer coefficient (KCO) (p less than 0.001) in the heavy smokers than in the non-smokers, despite the fact that the non-smokers had worked longer in the cotton mills (p less than 0.02). The mean TLCO was significantly lower than predicted in the heavy smokers (p less than 0.001) but not in the non-smokers. A significant negative correlation was found between the number of cigarettes smoked per day and the TLCO (p less than 0.01), TLCO % predicted (p less than 0.001), and KCO (p = 0.005), but not with the number of years spent in the carding area. These results provide evidence supporting recent pathological observations that emphysema is probably due to concomitant cigarette smoking and is not itself a feature of byssinosis.     

The impact of quitting smoking on symptoms of chronic bronchitis: results of the Scottish Heart Health Study.

Scotland has high rates of death from diseases of the respiratory system and high rates of smoking, especially among women. Data on self reported smoking and prevalence of chronic cough and chronic phlegm among 10,359 men and women aged 40-59 years were obtained from the Scottish Heart Health Study. Overall, current cigarette smokers had rates of chronic cough and chronic phlegm four to five times those of never smokers after standardisation for age (32.3% v 6.5% for men and 24% v 5.5% for women for chronic cough; 31% v 8.3% for men and 21% v 5.5% for women for chronic phlegm). Ex-smokers' symptom rates were a little above those of never smokers and were significant for chronic cough among women and chronic phlegm among men. Men had higher symptom rates than women and this was true for smokers, ex-smokers, and never smokers. The higher rates among men could not be explained by higher cotinine concentrations. Tests to detect "deceivers" among ex-smokers and never smokers using biochemical validation suggested that 87 (1.5%) respondents were in fact smoking; they were excluded from analyses. There were substantially lower rates of chronic cough and chronic phlegm within a year of stopping smoking, and two to four years after stopping 89-99% of the difference between current smokers and never smokers was accounted for (99% and 93% for men and women with chronic cough, 96% and 89% for men and women with chronic phlegm). Even 10 years after stopping, rates of symptoms among ex-smokers remained a little above those of never smokers (except for women with chronic phlegm), though these differences were not statistically significant. Former heavy smokers continued to have rates of chronic cough and chronic phlegm that were higher than those of former light and moderate smokers (though not significantly so). These are cross sectional data, but they emphasise the importance for chronic bronchitis symptoms of giving up cigarette smoking, though the amount previously smoked continues to exert a small influence.     

Childhood smoking is an independent risk factor for obstructive airways disease in women

OBJECTIVE: To assess whether starting to smoke in childhood increases the risk of obstructive airways disease (OAD) in adult life. METHODS: A retrospective cohort analysis was undertaken of 12 504 current and ex-smokers in the EPIC-Norfolk cohort. The main exposure was starting to smoke during childhood (age <16 years). Three definitions of OAD were used: doctor diagnosed asthma, doctor diagnosed bronchitis/emphysema, and "any OAD" (doctor diagnosed asthma or bronchitis/emphysema, or taking medication used in the treatment of OAD). RESULTS: Childhood smokers had significantly more pack years of exposure and poorer lung function than subjects who started to smoke in adulthood (>/=16 years). Compared with starting in adulthood, starting to smoke in childhood was associated with a greater risk of bronchitis/emphysema in female smokers (OR 1.79, 95% CI 1.25 to 2.56) and ex-smokers of both sexes (OR 1.29, 95% CI 1.07 to 1.55 in men and OR 1.40, 95% CI 1.05 to 1.85 in women), and of "any OAD" in female smokers (OR 1.72, 95% CI 1.24 to 2.38) and male and female ex-smokers (OR 1.20, 95% CI 1.03 to 1.40 in men and 1.34, 95% CI 1.07 to 1.57 in women). After adjustment for pack years, childhood smoking was associated with poorer lung function (FEV(1) 92.3% predicted in adult smokers and 89.5% in childhood smokers, p = 0.03) and a greater risk of bronchitis/emphysema (adjusted OR 1.55, 95% CI 1.08 to 2.24) and for "any OAD" (OR 1.54, 95% CI 1.10 to 2.13) in female smokers but not in male and female ex-smokers. CONCLUSION: Starting to smoke in childhood is associated with an increased risk of airways disease because of the extra pack years smoked. In women, childhood smoking is itself an independent risk factor for the development of airways disease.