Relation of education and occupation-based socioeconomic status to incident Alzheimer's disease

In this study, the authors evaluated whether the association between low educational level and increased risk of Alzheimer's disease (AD) and dementia may be explained by occupation-based socioeconomic status (SES). A cohort of 931 nondemented subjects aged > or = 75 years from the Kungsholmen Project, Stockholm, Sweden, was followed for 3 years between 1987 and 1993. A total of 101 incident cases of dementia, 76 involving AD, were detected. Less-educated subjects had an adjusted relative risk of developing AD of 3.4 (95% confidence interval: 2.0, 6.0), and subjects with lower SES had an adjusted relative risk of 1.6 (95% confidence interval: 1.0, 2.5). When both education and SES were introduced into the same model, only education remained significantly associated with AD. Combinations of low education with low or high SES were associated with similar increased risks of AD, but well-educated subjects with low SES were not at high risk. Low SES at 20 years of age, even when SES was high at age 40 or 60 years, was associated with increased risk; however, this increase disappeared when education was entered into the model. In conclusion, the association between low education and increased AD risk was not mediated by adult SES or socioeconomic mobility. This suggests that early life factors may be relevant.     

Effects on birthweight of alcohol and caffeine consumption in smoking women.

STUDY OBJECTIVE--Previous work found no effect on birthweight of alcohol and caffeine consumption in non-smokers but such an effect was found in smokers. This report investigates further the effects on birthweight of alcohol and caffeine at three stages of pregnancy in smoking women. DESIGN--This was a prospective population study. SETTING--District general hospital in inner London. PARTICIPANTS--Out of 1309 women who completed all pregnancy interviews, 895 were excluded because they did not smoke, leaving a sample of 414 smokers. MEASUREMENTS AND MAIN RESULTS--Number and brand of cigarettes smoked, and quantity of alcohol and caffeine consumed were obtained by interview at booking, 28, and 36 weeks gestation. Birthweight was corrected for gestation and adjusted for maternal height, sex of infant and parity. The effect on birthweight of alcohol consumption was not explained by the amount smoked in terms of quantity and yield. Similarly the effect of caffeine was independent of smoking. When alcohol, caffeine, and smoking were analysed together, alcohol and caffeine were both associated with reductions in birthweight. Alcohol was associated with a reduction of up to 8% after adjusting for tobacco and caffeine intake, and caffeine was associated with a reduction of up to 6.5% after adjusting for tobacco and alcohol intake. Women who at booking were heavy smokers (greater than or equal to 13 cigarettes/day or greater than or equal to 15 mg carbon monoxide/cigarette), heavy drinkers (greater than or equal to 100 g/week alcohol), and had high caffeine intake (greater than or equal to 2801 mg/week) had a predicted reduction in mean birthweight of 18% (95% CI 11% to 24%). CONCLUSIONS--It is well known that women who smoke in pregnancy have smaller babies than non-smokers. Our study suggests that if these women also drink alcohol and high quantities of caffeine then the risk of poor fetal growth is increased even further.     

Parkinson's disease risks associated with cigarette smoking, alcohol consumption, and caffeine intake

A reduced risk for Parkinson's disease (PD) among cigarette smokers has been observed consistently during the past 30 years. Recent evidence suggests that caffeine may also be protective. Findings are presented regarding associations of PD with smoking, caffeine intake, and alcohol consumption from a case-control study conducted in western Washington State in 1992-2000. Incident PD cases (n = 210) and controls (n = 347), frequency matched on gender and age were identified from enrollees of the Group Health Cooperative health maintenance organization. Exposure data were obtained by in-person questionnaires. Ever having smoked cigarettes was associated with a reduced risk of PD (odds ratio (OR) = 0.5, 95% confidence interval (CI): 0.4, 0.8). A stronger relation was found among current smokers (OR = 0.3, 95% CI: 0.1, 0.7) than among ex-smokers (OR = 0.6, 95% CI: 0.4, 0.9), and there was an inverse gradient with pack-years smoked (trend p < 0.001). No associations were detected for coffee consumption or total caffeine intake or for alcohol consumption. However, reduced risks were observed for consumption of 2 cups/day or more of tea (OR = 0.4, 95% CI: 0.2, 0.9) and two or more cola drinks/day (OR = 0.6, 95% CI: 0.3, 1.4). The associations for tea and cola drinks were not confounded by smoking or coffee consumption.     

Reliability of recalled physical activity, cigarette smoking, and alcohol consumption.

Reliability of recalled measures of physical activity and alcohol and tobacco use was examined in a cohort of 873 men and women in three California communities. In personal interviews in 1972, participants provided baseline data on these three habits. In repeat interviews in 1983, they recalled their habits in 1972 and reported their current habits. On average, recalled physical activity levels significantly exceeded those originally reported (1899 kcal/d versus 1345 kcal/d, P < 0.001) and were similar to current reported levels (1822 kcal/d). Similarly, recalled alcohol and cigarette consumption was higher than the original reports (alcohol: 126 versus 119 g/wk; cigarettes: 8.5 versus 6.2/d). By contrast, current reported alcohol (103 g/wk) and cigarette consumption (4.6/d) were lower than at baseline. Analysis of variance was used to partition the variation in recalled and original habits into components due to interpersonal variation in true measures, errors in recall, and residual reporting error. Interpersonal variation accounted for only 20% of the total variation in physical activity, but for 48 to 60% of total variation in cigarette smoking and alcohol consumption. These results suggest that inconsistencies among studies of chronic disease and physical activity may arise from either large random measurement errors in individual assessments or from homogeneity of activity levels among the populations studied.     

Influence of smoking and alcohol consumption on blood lead levels

Summary Blood lead levels were determined in 88% of all men and women born in 1936 and residing in four suburbs of Copenhagen, i.e., 504 men and 548 women. Smoking habits and alcohol consumption were assessed by interview and were found to be independent of other indicators of lead exposure. Increased blood lead levels of smokers could, for the most part, be explained by augmented alcohol intake as indicated by the partial correlation coefficient and by the relationship between alcohol consumption and lead levels in nonsmokers. Further, smoking contributed little to the blood lead levels of individuals who did not consume any alcohol. A multivariate analysis indicated that one unit of alcohol (1.35 cl pure ethanol) per day might contribute 0.5-1.0 g lead/100 ml blood. No significant difference was found between the influence of beer, wine, and hard liquor.This study was supported by the Danish Health Insurance Foundation (H6/85-75, H11/54-76, H11/60-77, H11/57-78). The Danish Heart Foundation and Danish Medical Research Council (5122-6646)     

Relation of the tocopherol forms to incident Alzheimer disease and to cognitive change

BACKGROUND: High intake of vitamin E from food (tocopherol), but not from supplements (which usually contain alpha-tocopherol), is inversely associated with Alzheimer disease. OBJECTIVE: We examined whether food intakes of vitamin E, alpha-tocopherol equivalents (a measure of the relative biologic activity of tocopherols and tocotrienols), or individual tocopherols would protect against incident Alzheimer disease and cognitive decline over 6 y in participants of the Chicago Health and Aging Project. DESIGN: The 1993-2002 study of community residents aged >or=65 y included the administration of 4 cognitive tests and clinical evaluations for Alzheimer disease. Dietary assessment was by food-frequency questionnaire. RESULTS: Tocopherol intake from food was related to the 4-y incidence of Alzheimer disease determined by logistic regression in 1041 participants who were clinically evaluated (n=162 incident cases) and to change in a global cognitive score determined by mixed models in 3718 participants. Higher intakes of vitamin E (relative risk: 0.74 per 5 mg/d increase; 95% CI: 0.62, 0.88) and alpha-tocopherol equivalents (relative risk: 0.56 per 5 mg/d increase; 95% CI: 0.32, 0.98) were associated with a reduced incidence of Alzheimer disease in separate multiple-adjusted models that included intakes of saturated and trans fats and docosahexaenoic acid. alpha- and gamma-Tocopherol had independent associations. In separate mixed models, a slower rate of cognitive decline was associated with intakes of vitamin E, alpha-tocopherol equivalents, and alpha- and gamma-tocopherols. CONCLUSION: The results suggest that various tocopherol forms rather than alpha- tocopherol alone may be important in the vitamin E protective association with Alzheimer disease.     

Joint effect of cigarette smoking and alcohol consumption on mortality

OBJECTIVE: To evaluate the joint effect of cigarette smoking and alcohol consumption on mortality. METHODS: A population-based cohort of 66,743 Chinese men aged 30-89 in Shanghai, China recruited from 1996 to 2000. Lifestyle data were collected using structured questionnaires. As of November 2004, follow-up for the vital status of 64,515 men was completed and death information was further confirmed through record linkage with the Shanghai Vital Statistics Registry. Associations were evaluated by Cox regression analyses. RESULTS: 2514 deaths (982 from cancers, 776 from cardiovascular diseases (CVD)) were identified during 297,396 person-years of follow-up. Compared to never-smokers, both former and current smokers had significantly elevated mortality from any cause, CVD, and cancer; risk increased with amount of smoking. Intake of 1-7 drinks/week was associated with reduced risk of death, particularly CVD death (hazard ratio (HR): 0.7, 95% confidence interval (CI): 0.5, 1.0), whereas intake of >42 drinks/week was related to increased mortality, particularly cancer-related death (HR: 1.7, 95% CI: 1.1, 2.5). The HR for total mortality associated with moderate alcohol consumption increased from 0.8 (95% CI: 0.6, 1.0) for non-smokers to 1.0 (0.9, 1.2) for moderate smokers and 1.4 (95% CI: 1.2, 1.7) for heavy smokers. Heavy drinkers and heavy smokers had the highest mortality (HR: 1.9, 95% CI: 1.6, 2.4). CONCLUSIONS: Light and moderate alcohol consumption reduced mortality from CVD. This beneficial effect, however, was offset by cigarette smoking.     

Cigarette smoking and alcohol consumption in relation to cognitive performance in middle age

In the elderly, cigarette smoking has been related to reduced cognitive performance and moderate alcohol consumption to increased cognitive performance. It is not clear whether these associations also exist in middle age. The authors examined these relations in a population-based cohort study of 1,927 randomly selected, predominantly middle-aged subjects aged 45-70 years at the time of cognitive testing and living in the Netherlands. From 1995 until 2000, an extensive cognitive battery was administered, and compound scores were calculated. Risk factors had been assessed approximately 5 years previously. Multiple linear regression analyses (in which one unit of the cognitive score = one standard deviation) showed that, after the authors adjusted for age, sex, education, alcohol consumption, and cardiovascular risk factors, current smokers had reduced psychomotor speed (beta = -0.159, 95% confidence interval: -0.071, -0.244; p = 0.0003) and reduced cognitive flexibility (beta = -0.133, 95% confidence interval: -0.035, -0.230; p = 0.008) compared with never smokers. This effect was similar to that of being approximately 4 years older. Alcohol consumption was related to increased speed and better flexibility, especially among women who drank 1-4 alcoholic beverages a day. In conclusion, among middle-aged subjects, current smoking was inversely and alcohol consumption positively related to psychomotor speed and cognitive flexibility. This finding suggests that actions to prevent cognitive decline can be taken in middle age.     

吸烟、饮酒与脑出血的配对病例对照研究

目的探讨吸烟、饮酒与脑出血的关系.方法采用配对病例对照研究方法将162例经颅脑CT扫描确诊的脑出血病例与同一医院非脑外科的病人对照作1∶1配比,进行条件logistic回归分析.结果饮酒可增加脑出血的危险性,饮酒与脑出血的OR间有明显的剂量反应关系(P＜0.05),但是按高血压病史调整以后,这种作用失去显著意义;未发现吸烟与脑出血有关(P＞0.05).结论饮酒可能是通过影响血压间接地增加患脑出血的危险性.     

Risk of papillary thyroid cancer in women in relation to smoking and alcohol consumption

Both smoking and alcohol consumption may influence thyroid function, although the nature of these relations is not well understood. We examined the influence of tobacco and alcohol use on risk of papillary thyroid cancer in a population-based case-control study. Of 558 women with thyroid cancer diagnosed during 1988-1994 identified as eligible, 468 (83.9%) were interviewed; this analysis was restricted to women with papillary histology (N = 410). Controls (N = 574) were identified by random digit dialing, with a response proportion of 73.6%. We used logistic regression to calculate odds ratios (OR) and associated confidence intervals (CI) estimating the relative risk of papillary thyroid cancer associated with cigarette smoking and alcohol consumption. A history of ever having smoked more than 100 cigarettes was associated with a reduced risk of disease (OR = 0.7, 95% CI = 0.5-0.9). This reduction in risk was most evident in current smokers (OR = 0.5, 95% CI = 0.4-0.7). Women who reported that they had ever consumed 12 or more alcohol-containing drinks within a year were also at reduced risk (OR 0.7, 95% CI = 0.5-1.0). Similar to the association noted with smoking, the reduction in risk was primarily present among current alcohol consumers. The associations we observed, if not due to chance, may be related to actions of cigarette smoking and alcohol consumption that reduce thyroid cell proliferation through effects on thyroid stimulating hormone, estrogen, or other mechanisms.     

The relationship of alcohol consumption to atherosclerotic heart disease

A review of the literature indicated that moderate alcohol consumers appear to have a lower rate of heart disease and a lower mortality than nondrinkers or heavy drinkers. A geographic analysis of 20 countries in 1972 suggested that moderate alcohol consumption appeared to be negatively related to rates of heart disease mortality. A temporal analysis within the United States indicated that changes in alcohol consumption, particularly beer, were highly negatively related to changes in heart disease mortality for 1950 to 1975. The review, in addition to the geographic and temporal analyses, suggests a U-shaped relationship between alcohol consumption and heart disease. Possible reasons for the negative relationship between moderate alcohol consumption and heart disease were discussed, including relationships to high-density lipoprotein cholesterol, changes in food patterns, and stress.     

The short- and long-run effects of smoking cessation on alcohol consumption

This paper examines the short- and long-term effects of quitting smoking on alcohol consumption using the Lung Health Study, a randomized smoking cessation program. The paper estimates the relationship between smoking and alcohol consumption using several self-reported and objective smoking measures, while also implementing a two-stage least squares estimation strategy that utilizes the randomized smoking cessation program assignment as an instrument for smoking. The analysis leads to three salient findings. First, self-reported and clinically verified smoking measures provide mixed evidence on the short-term impact of quitting smoking on alcohol consumption. Second, the long-term impact of smoking on alcohol consumption, measured with the historic 5 years smoking behavior, suggests that those with the highest average cigarette consumption and those with the longest smoking history see the largest increase in alcohol consumption. Specifically, abstaining from smoking or reducing the average cigarette consumption to the mean level lowers alcohol consumption by roughly 25% per week. As a result, these findings present comprehensive evidence that smoking and drinking are complements in the long-term and that the public health and finance benefits in smoking cessations treatments are undervalued.     

吸烟、饮酒与胃癌关系的条件logistic回归分析

目的探索吸烟、饮酒及其交互作用与胃癌发生的关系。方法采用配对病例对照研究,收集了2003年8月~2004年8月303例胃癌新发病例和303例健康对照。对可能的危险因素进行了单因素、调整混杂因素(10年前人均年收入、文化程度、性格、慢性胃部疾病史)的条件lo-gistic回归分析,估计其OR值及95%置信区间。结果调整前后,随着吸烟年数延长、每天吸烟量增大及吸烟包年数增多,胃癌的OR值呈上升趋势(趋势检验,P=0.0214、P=0.0121、P=0.0009)。吸烟年限>30年、每天吸烟量>20支和综合指标吸烟包年数>20者均显示出与胃癌有较强的正关联,其调整后的OR值分别是4.54(95%CI=1.20~17.13)、5.65(95%CI=1.43~22.29)和7.25(95%CI=1.70~30.84);未发现饮酒与胃癌有统计学关联(P=0.242)、未发现调整混杂因素后饮酒与吸烟之间有交互作用,其交互项Waldχ2=0.0276,P>0.05。结论吸烟与胃癌的发病呈正相关;单独饮酒与胃癌发生无明显关系,饮酒并不增加吸烟者患胃癌的风险,两者无协同作用。     

Chronic nonspecific lung disease and alcohol consumption

The relationship of the symptoms and signs of chronic nonspecific lung disease and alcohol consumption was studied in a group of 763 male workers aged 20–59, mean age 37 years. The effects of concurrent smoking habit and age were also considered. The results obtained indicate that in addition to being associated with the use of tobacco and age, respiratory symptoms and ventilatory impairment are also related to alcohol consumption. This is particularly true for the syndrome of chronic bronchitis.     

潮汕地区部分人群吸烟及饮酒情况调查

目的调查潮汕地区部分人群吸烟及饮酒情况。方法在汕头市和汕尾市采用整群抽样方法调查640名19~82岁当地居民的吸烟、饮酒习惯。结果分别调查汕头市和汕尾市300、308名居民,其吸烟率分别为50.7%、41.6%,饮酒率分别为21.3%、25.3%。两地男性吸烟率、饮酒率均高于女性(均P<0.01)。两地居民职业别人均累计吸烟量和饮酒量差异均有统计学意义(均P<0.05),以渔民、农民、工人为高。结论潮汕地区部分男性居民,尤其是从事工农渔业者是烟酒的主要消费人群,也是重点的健康教育对象。     

Cigarette smoking and alcohol consumption in the aetiology of uterine cervical cancer

A case-control study of uterine cervical cancer was conducted using 331 cases and 993 age-matched controls identified through the Missouri Cancer Registry during 1984-1986. Patients with smoking- or alcohol-related cancers were excluded from the control series. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (Cls) after adjustment for age, cigarette smoking, alcohol consumption, and stage at diagnosis. A dose-response relation was observed between intensity of cigarette smoking and invasive cervical cancer, with light and heavy smokers having elevated risks (OR = 2.2, 95% Cl = 1.4-3.6 and OR = 3.9, 95% Cl = 2.7-5.6, respectively). Former smokers had less elevated risk (OR = 1.7, 95% Cl = 1.0-2.9), a finding consistent with a greater effect of tobacco smoke on late-stage carcinogenesis. Similar results were obtained in age- and control site-specific analyses. Further, the age-specific data suggested a dose-response relation between duration of smoking and invasive cervical cancer. An association between alcohol consumption and invasive cervical cancer was not observed.