Smoking habits, exposure to passive smoking and attitudes to a non-smoking policy among hospital staff

A survey was carried out into the smoking habits and exposure to passive smoking among health staff in the hospitals of Faenza, Forli and Rimini (Emilia-Romagna, Northern Italy). 2453 subjects answered anonymously a 41 question questionnaire. 53% of the subjects were professional nurses, 16% doctors, 15% maintenance staff, 10% ancillary staff, 1% non-medical graduates, 2% were administrators and 3% were assigned to the category ‘others’.Of the subjects answering the questionnaire 39% were smokers, 19% ex-smokers and 42% non smokers. The highest number of smokers was found among women (41%) compared to men (37%) and among ancillary staff (48%) compared to nurses (41%) and doctors (31%). The males were mostly heavy smokers (≥20 cigarettes/d) and smoked strong cigarettes (≥12 mg/cig condensate content). The females were mostly light smokers (<10 cigarettes/d) and smoked light cigarettes (1–6 mg/cig condensate content). A high percentage of subjects (87%) smoked at work especially in areas reserved for staff. 43% and 26% of shift workers and non-shift workers tended not to modify their habit when on morning or afternoon shifts. During night shifts the majority of them increased their tobacco consumption.Around 87% of hospital employees stated they were exposed to passive smoking inside the hospital especially in cooking areas, at information desks and corridors. Nurses, ancillaries and maintenance staff were those most exposed and for a greater number of hours per day compared to doctors. Almost all subjects were aware of the harm caused by passive smoking. 56% of smokers, 65% of ex-smokers and 72% of non smokers said they were willing to participate in future campaigns to limit smoking in their hospitals.     

中国居民吸烟行为的现状分析

目的分析我国居民吸烟行为,为有针对性地制定控烟措施提供基础资料.方法使用2002年中国居民营养与健康状况调查数据,对167063名（男76 556人,女90507人）15岁及以上居民的吸烟行为,包括吸烟率、现在吸烟率、常吸烟率、重型吸烟率、平均吸烟量、吸烟类别、戒烟率、戒烟成功率、复吸率及被动吸烟率等进行描述性分析.结果我国15岁及以上居民吸烟率为24.0%,男性（50.2%）明显高于女性（2.8%）,现在吸烟率为23.6%,男性（49.6%）明显高于女性（2.8%）.98.8%的男性及几乎全部女性吸烟者为现在吸烟者,95.1%的男性及92.9%的女性现在吸烟者为常吸烟者,46.0%的男性及21.4%的女性现在吸烟者为重型吸烟者.农村居民上述指标均高于城市居民.我国18岁及以上吸烟者中81.3%主要吸有过滤嘴香烟,11.9%主要吸手卷烟或旱烟,4.2%主要吸无过滤嘴香烟,2.3%主要吸烟斗或水烟袋,0.3%主要吸雪茄.结论我国居民中吸烟率仍然很高,烟草控制仍然面临着巨大的挑战,应采取有针对性的措施,有效地控制烟草的消费.     

中国慢性病前瞻性研究:10个项目地区成年人群吸烟行为特征差异分析

目的 描述中国慢性病前瞻性研究(CKB)10个项目地区成年人群吸烟行为特征的地区差异。方法 剔除CKB基线调查时自报患有冠心病、卒中、肿瘤和慢性阻塞性肺病的个体,分析10个项目地区452 829名30～79岁调查对象吸烟行为的地区差异。 结果 男性当前吸烟率(64.2%)明显高于女性(2.1%)。哈尔滨(10.5%)和四川(8.5%)项目地区的女性当前吸烟率明显高于其他地区;湖南和四川项目地区男性当前吸烟率(68.8%和67.2%)及每日吸烟量(20.9支和21.5支)均较高;海口当前吸烟率虽然最低(49.9%),但每日吸烟量最高(21.9支);甘肃当前吸烟率最高(71.4%),但每日吸烟量较低(14.9支)。男性当前吸烟者以过滤嘴香烟的使用率最高(88.3%);手卷烟/旱烟主要见于四川(38.8%)和甘肃(37.8%),而烟斗/水烟主要见于河南(14.6%)项目地区。 结论 CKB的10个项目地区人群无论在吸烟率还是吸烟者使用烟草品种、吸烟量、吸入深度等特征上均存在明显的地区差异。     

THE SMOKING HABITS AND ATTITUDES OF NURSES

The demographic and social characteristics, attitudes to smokers and smoking, and knowledge about smoking were surveyed in 988 (81.3%) of 1,215 trainee and trained nurses in four locations in Perth, Western Australia. Male and female nurses were similar with 51% never having smoked regularly, 17% being ex-smokers and 32% current smokers. In comparison with Australian woman in general, there were less current smokers and more ex-smokers among female nurses. Female nurses smoked substantially more than Australian female doctors. The majority of nurses who had ever smoked (68%) began smoking between ages 15 and 19 years, 26% began in the first year of their nursing training and 26% smoked their first cigarette in the nurses' quarters. The knowledge of nurses about the health effects of smoking was similar to that of Australian doctors as were their opinions regarding their role in setting a non-smoking example to others. A substantial majority supported either a complete ban on smoking, or its restriction to especially segregated areas in aeroplanes, buses, trains, hospitals and cinemas.     

Social acceptance of smoking regulations in the workplace: A study from Southern Germany

Smoking regulations in the workplace are increasingly employedto protect non-smokers against passive smoking. Nevertheless,concern about their social acceptance hinders their implementationin many instances. Social acceptance of worksite smoking regulationswas assessed in a cross-sectional study, which was conductedin 1992 among 930 employees of a Southern German telephone company.A minority of 16.5% among employees who smoked felt discriminatedagainst. Perceived discrimination of smokers was strongly associatedwith the number of cigarettes smoked per day, but not with existingsmoking regulations. Most smokers (79.2%) and non-smokers (94.9%)were in favour of some type of smoking restrictions; proportionswere even higher in workplaces where smoking restrictions werealready in effect. Among current smokers, a preference for smokingrestrictions was positively associated with a desire to stopor reduce smoking. These results suggest that smoking regulationsin the workplace can be accepted by smokers and non-smokersand are perceived as an aid to stop or reduce smoking ratherthan a discriminating measure among current smokers.     

Sport activity and cigarette smoking among young and adult athletes from the northeastern part of Italy

Between November 1985 and October 1986, attitudes and habits towards smoking were investigated among young and adult amateur athletes of the province of Pordenone, in the northeastern part of Italy. Seventy-five percent of the athletes had never smoked and 21% were current smokers. Compared with the general population, smokers were 1/3 fewer among males and 1/5 more among females; a higher number of ex-smokers was found in both sexes. The major determinants of smoking were the kind of sport in which the athletes were engaged (percentages of current smokers among athletes of endurance sports, football and other, less exhaustive, sports were respectively 3%, 23% and 20%) and having both parents who were themselves smokers. The detrimental effects of smoking on health were underestimated by the great majority of interviewed subjects. The present study supports the view that regular phsical activity not only prevents youths from starting to smoke but also provides an incentive for stopping.     

Smoking rates among Rhode Island physicians: achieving a smoke-free society.

Over a 25-year period, regular surveys of physicians licensed in Rhode Island have recorded their smoking behavior. The six surveys show a decrease in the rate of cigarette smoking from 33% in 1963 to 4.6% in 1988. In the most recent survey, 65% of respondents reported never having smoked, and 87% of those who had ever smoked reported having quit. However, the statistic for the maximum number of cigarettes smoked regularly was higher for current smokers than for former smokers. Among physicians in the 1988 survey, most former smokers (85%) reported using only unassisted personal effort in quitting, whereas nearly half (48%) of current smokers tried methods involving assistance, such as self-help programs, group programs, or nicotine gum. Among former smokers who quit after 1983, the percentage trying assisted methods (34%) was closer to the percentage among current smokers. Apparently, remaining smokers include many heavy smokers who require more potent interventions in order to quit. Physicians in Rhode Island have almost become a smoke-free group. Their experience, coupled with their involvement in smoking prevention and cessation for their patients, can lead the rest of society on its path to becoming smoke-free.     

The Belgian heart disease prevention project: Changes in smoking habits after two years of intervention

The Belgian Heart Disease Prevention Project is a controlled multifactorial prevention trial involving 19,390 men aged 40–59 years, employed by 30 Belgian industries. These industries were paired and randomized into a control or intervention unit. In each intervention factory, the subjects from the two highest deciles of a coronary risk score distribution curve were given semiannual individual advice. Furthermore, a health education campaign was organized in each intervention factory. In the control group, 10% of randomly chosen subjects had the same baseline examination as the whole of the intervention group.After 2 years, high-risk subjects as well as random samples of the control and intervention group were compared regarding smoking behavior. Among the high-risk subjects of the intervention group, 18.7% stopped smoking against 12.2% in the control group (P ? 0.05). The random samples of both the intervention and control groups showed an almost identical quitting rate (12.5 and 12.6%). The drop in the number of cigarettes smoked daily by smokers at 2 years was significantly different when comparing the high-risk subjects of the intervention and control groups: 18.8 and 9.1% (P ? 0.01). In a stepwise discriminant function analysis three baseline factors discriminated significantly between high-risk ex-smokers and smokers of the intervention group at 2 years: number of cigarettes smoked daily at entry, earlier attempts to stop smoking, and geographic location in Belgium. For the control group, two baseline factors discriminated between ex-smokers and smokers at 2 years: study level and earlier attempts to stop smoking.     

Cigarette smoking and stages of change among men and women in Kiev,Ukraine

BACKGROUND: Assisting current smokers to progress towards stopping smoking entails identifying their readiness to stop and understanding the factors that may influence their readiness. Relations were established between certain predictor variables (intensity of smoking, age at initiation, duration of smoking, and gender) and stages of readiness to change smoking behaviour in Kiev, Ukraine. METHODS: Analysis was based on a convenient sample of 536 current smokers who completed a stages-of-change questionnaire in a public square in the centre of Kiev's business district, between 22 and 25 July 2000. Frequency distributions, odds ratios, the Kolmogorov-Smirnov test and the Wilcoxon rank-sum test were used to summarize and describe the data. Tests of significance were based on the 0.05 level. RESULTS: The majority of participants (56.1%) were categorized as precontemplative. Less than 20% of the subjects were prepared for action to change smoking behaviour. Later age at smoking initiation was associated with fewer cigarettes smoked per day. Females were more likely then males to seriously consider cutting down the number of cigarettes they smoked. However, males were more likely to have intentionally quit smoking for at least one day within the past year. CONCLUSION: Information on stages of readiness to stop smoking provided by this study may be useful for improving the effectiveness of smoking cessation programmes in Kiev.     

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.     

Nonspecific inflammatory bowel disease and smoking

The authors assessed the relation between cigarette smoking and nonspecific inflammatory bowel disease in a case-control study of 124 cases of ulcerative colitis, 109 cases of Crohn's disease, and 250 age- and sex-matched control subjects in hospital for acute nongastric or intestinal conditions unrelated to smoking. For ulcerative colitis, the risk for current smoking compared with never smoking was 0.5, with a 95% confidence interval (Cl) of 0.3-1.0. They observed decreasing risk with increasing number of cigarettes smoked. The risk for ex-smokers, however, was greater than that for never smokers (relative risk = 2.7; 95% Cl = 1.5-4.9). The elevated risk of ulcerative colitis in ex-smoking in the presence of an overall lack of association with ever-smoking may plausibly be attributed to either 1) brief induction time of a protective effect of smoking on ulcerative colitis or 2) selective cessation of smoking due perhaps to very early symptoms of the disease. If time at first onset of bowel symptoms, instead of clinical diagnosis, is considered as the index date, the negative association between ulcerative colitis and current smoking would have weakened in men and disappeared in the overall series. There was clear evidence of a positive association between cigarette smoking and Crohn's disease (relative risk for ever smokers vs. never smokers = 4.0; 95% Cl = 2.2-7.3). The risk estimates increased with the number of cigarettes smoked per day and duration of habit. The association between current smoking and Crohn's disease was even stronger when age at first onset of bowel symptoms was considered as the index date, but the risk for ex-smokers fell below unity.     

Discrimination of smoking status by thiocyanate and cotinine in serum, and carbon monoxide in expired air.

To develop a procedure for maximizing the discrimination of smoking status, the authors analysed parallel samples of thiocyanate and cotinine in serum, and carbon monoxide (CO) in expired air in a cohort of 145 male subjects aged 45-65 years. The sensitivity and specificity were 93% and 82%, 97% and 83%, and 98% and 100% for thiocyanate, cotinine, and CO respectively. The results were not significantly improved when combining two or three methods as compared with CO separately. Also, cotinine in urine was analysed in a subgroup of 21 subjects. The correlation coefficient between cotinine in serum and urine was 0.92. In a subgroup of 44 subjects with extensive information on smoking habits, CO was the only indicator significantly related to the quantity of tobacco smoked. We conclude that CO seems sufficient for validating smoking status, but as atypical smokers who are vulnerable to misclassification may be overrepresented in smoking cessation programmes, combining two methods could still be useful. Validating the amount of tobacco smoked is of limited use with the current methods.     

Cigarette smoking and the risk of breast cancer

The authors examined the relation between cigarette smoking and breast cancer in the Centers for Disease Control Cancer and Steroid Hormone Study, a multicenter, population-based case-control study. The study compared 4,720 women aged 20-54 years with newly diagnosed breast cancer identified through population-based tumor registries with 4,682 women randomly selected from the same geographic areas. Women who reported ever smoking cigarettes had a risk of breast cancer of 1.2 (95 percent confidence interval 1.1-1.3) compared with never smokers. There was no consistent dose-response pattern with any measure of smoking (pack-years of smoking, average number of cigarettes per day, or total years smoked) and little difference in risk between current and former smokers. There was some variation in risk by age, with slightly higher risk estimates for younger women than for older women. Although current smokers had an earlier natural menopause than did never smokers, the authors found no evidence of a protective effect of cigarette smoking on breast cancer risk. These findings suggest that the risk of breast cancer in women who smoke is the same as, or perhaps slightly higher than, women who have never smoked.     

Determinants of salivary cotinine concentrations in Chinese male smokers

BACKGROUND: Identifying factors that affect cotinine levels in smokers may be useful for smoking cessation programs. Our aims were to characterize the distribution of salivary cotinine levels in Chinese smokers and to investigate factors that influence cotinine concentrations. METHODS: In a cross-sectional study, 600 Chinese adult smokers answered a questionnaire on smoking habits and provided a saliva sample for cotinine analysis. Modification of the relation between number of cigarettes smoked and cotinine concentration by individual characteristics, smoking behavior, and type of tobacco was evaluated. RESULTS: Quadratic model provided the best fit for the relation between number of cigarettes smoked in the previous 24 hours and salivary cotinine concentration. Among those smoking up to 20 cigarettes, the median cotinine concentration was higher among younger subjects, those smoking cigarettes without filter and regular rather than light cigarettes, and those inhaling frequently and deeply. Such trends were not observed among heavier smokers. The increase in cotinine per cigarette tended to be larger in those with lower median cotinine level. CONCLUSIONS: Our findings show that smoking behavior-related factors modify the relation between number of cigarettes smoked and salivary cotinine concentration. This suggests that smokers may regulate their smoking behavior to achieve a certain optimum nicotine level.     

Analysis of influential factors associated with the smoking behavior of aboriginal schoolchildren in remote Taiwanese mountainous areas

BACKGROUND: A disparity in smoking behavior exists between the general and minority populations residing in Taiwan's mountainous areas. This study analyzed individual and environmental factors associated with children's smoking behavior in these areas of Taiwan. METHODS: In this school‐based study, data on smoking behavior and related factors for mountain‐dwelling students were obtained from the 2008 and 2009 Control of School‐aged Children Smoking Study surveys. A representative sample (N = 1239) from 26 primary schools was included. The association among 3 groups (never‐, former‐, and current‐smokers) and the potential variables were simultaneously examined using unordered polytomous logistic regression analysis. RESULTS: Between 13% and 34% of ever‐smokers reported that their first smoking experience was in third grade. More than 70% were found to have bought cigarettes and 87% reported that the tobacco retailers had sold them cigarettes. The significant factors for current‐smokers were predisposing factors, ie, attitude toward smoking (adjusted odds ratio [AOR] = 1.21); reinforcing factors, ie, family smoked in front of me (AOR = 2.44), friends smoked in front of me (AOR = 16.24), and school staff smoked in front of me (AOR = 2.98); and enabling factors, ie, cigarette availability and accessibility (AOR = 2.16 and 2.42, respectively). A student's perceived punishment for smoking at school had a positive significant effect on the risk of being former‐smokers (AOR = 1.57). CONCLUSION: The findings provide a basis for school and community to design and implement effective anti‐smoking programs for remote mountain‐based students to further reduce youth smoking.     

Cigarette smoking and coronary heart disease in Puerto Rico

Cigarette smoking habits were assessed in over 9000 men, aged 45–64 years, who participated in a prospective study of coronary heart disease (CHD) in Puerto Rico beginning in 1965. Fewer Puerto Rican men smoked cigarettes, and they smoked fewer cigarettes per day than in comparable studies in the mainland United States. Even in this lower-smoking, low-CHD population, cigarette smoking showed a significant independent association with the incidence of myocardial infarction (MI) over an 8-year period both in the rural and urban areas; however, this association was not statistically significant for other manifestations of CHD. Pipe and cigar smokers had a risk of MI similar to nonsmokers. Those men who used filter cigarettes or who stated that they did not inhale showed the same risk of MI as other cigarette smokers. Ex-smokers had a risk of MI intermediate to that of nonsmokers and current smokers. The risk of MI did not increase with an increase in the number of cigarettes smoked, but the risk of MI in smokers as a group relative to those who had never smoked was 3.4 in the rural area and 2.0 in the urban area. These results emphasize that there is an excess risk of MI in those cigarette smokers who report that they used filter cigarettes, did not inhale, or smoked a small number of cigarettes a day.     

Smoking during labour.

Smoking in hospitals is now forbidden. In several hospitals, however, women in labour are allowed to smoke in designated smoking areas. This study assesses whether smoking during labour increases the carboxyhaemoglobin concentrations in maternal and cord blood, taking into account the number of cigarettes smoked during pregnancy, duration of labour and parity. Women were questioned on their smoking behaviour shortly after delivery. A total of 295 mother-infant pairs were included in the study. Of the 94 (31.9%) smokers, 33 smoked during labour at home only and 34 during labour at the hospital. For newborns of smokers, the daily ration of cigarettes smoked by the mother during pregnancy and the number smoked during labour explained respectively 10.4% and 10.8% of the residual variance of carboxyhaemoglobin in cord blood. Smoking during labour significantly increases carboxyhaemoglobin levels. It should be prohibited in hospitals.     

广州市城乡结合部初中生吸烟行为特点的调查

目的:了解城乡结合部青少年吸烟行为的特点。方法:用自填式调查表对6所中学3 956名初中生进行流行病学调查。结果:初中生的尝试吸烟率为20.4%(男30.4%,女8.9%),不规律吸烟率14.7%(男21%,女7.7%),规律吸烟率5.7%(男9.4%,女1.2%)。吸烟率在不同性别和年级间存在差异,不同生源地的初中生吸烟率也有所区别。大部分尝试吸烟行为发生于10~14岁,初吸烟年龄中位数为12岁。吸第一支烟最主要的原因是“好奇尝试(70.3%),最主要的影响人是同伴(46.3%)。73%的规律吸烟者在过去1个月吸过烟,27%的只吸了1~5天。现在吸烟者的日均吸烟量平均值为5.12支,中位数为3支。46.6%的吸烟者只将烟雾吸入口腔。获得香烟的主要方式是别人给的,吸烟主要发生于伙伴聚会时。59%的规律吸烟者曾经戒过烟,主要是由于健康的缘故,戒烟成功率为28.8%。48.9%的现在吸烟者表明目前有戒烟的打算。结论:城乡结合部已成为烟草流行的重灾区,此趋势在青少年已有所表现。青少年控烟工作要联合政府、社会、家庭和学校等方多力量,结合其心理特征开展诸如同伴教育、提供戒烟辅助等有效措施。     

CRP levels are elevated in smokers but unrelated to the number of cigarettes and are decreased by long-term smoking cessation in male smokers

BACKGROUND: It is not clear whether there is a dose-response relationship between the number of cigarettes smoked per day and CRP level and whether there is a relationship between the length of smoking cessation and CRP level. METHODS: Geometric mean levels of CRP were compared in smoking status groups for 1926 men aged 40 to 69 years using analysis of covariance. RESULTS: After adjusting for several confounding factors, geometric mean levels of CRP (mg/L) were significantly different among the three smoking status groups (0.41 in non-smokers, 0.57 in current smokers, 0.48 in past smokers, P < 0.05). A linear trend was not found in the relationship between CRP level and number of cigarettes smoked per day. The mean CRP level in the long cessation (> or =5 years) group was significantly lower than that in the short cessation (<5 years) group (0.45 vs. 0.58, P < 0.05) and similar to that in the non-smokers group (0.45 vs. 0.41, NS). CONCLUSIONS: CRP levels in current smokers are elevated but unrelated to the number of cigarettes smoked per day. In past smokers, long-term smoking cessation may contribute to the reduction in risk of development of cardiovascular diseases through inflammatory mechanisms.     

Smoking habits and associated factors among Greek physicians

OBJECTIVE: To investigate the smoking habits and associated risk factors among Greek physicians. STUDY DESIGN: Cross-sectional survey of a randomly selected sample of Greek physicians. METHODS: A national sample of 1284 physicians (718 men, 566 women) participated in the study, which was conducted between September 2003 and June 2005. Data were collected through an anonymous self-completed questionnaire. Logistic regression was used to analyse the influence of different factors on the probability of a physician being a current or former smoker. RESULTS: Overall, 38.6% of the physicians (40% of men; 37% of women) currently smoked, 13.8% were former smokers, and 47.6% had never smoked. Eighty-three per cent of smokers reported starting smoking before the age of 25 years, with half of them during medical school (aged 19-24 years). Multivariate analyses revealed that physicians who were male, unmarried, divorced or widowed, surgeons or anaesthetists, and residents were more likely to be current smokers. Former smokers were more likely to be older, male and born in a rural area. Moreover, the odds of being a current or former smoker were significantly higher among physicians with a history of parents who smoked. The proportion of physicians who reported counselling patients (often or always) to stop smoking was lower among current smokers compared with those who never smoked or those who were former smokers (74.4% vs. 85.3% vs. 84.7%, P<0.0001). CONCLUSIONS: The prevalence of smoking among Greek physicians is exceedingly high and similar to that of the general population. More effective interventions that reduce smoking in the medical community should be implemented immediately so that physicians will be better able to fulfil their function as role models for the general population.