Peer beliefs and smoking in adolescence: a longitudinal social network analysis

ABSTRACT

Background: Peer smoking is one of the strongest predictors of adolescent cigarette use, but less is known about whether other peer characteristics also contribute to this behavior. Objectives: This study examined the links between adolescent cigarette use and peer beliefs about smoking. It tested whether peer beliefs about smoking are associated with changes in cigarette use, whether this association is a result of changes in individual beliefs about smoking, and how beliefs inform friendship choices. Methods: Analyses drew on data collected from 29 school-based networks, each measured at five occasions as students moved from 6th through 9th grade, as part of the study of the PROSPER partnership model. Longitudinal social network models provided estimates of friendship selection and behavior for an average of 6,200 students at each measurement point and more than 9,000 students overall. Results: Peer beliefs about smoking influenced cigarette use both directly and through their impact on individual beliefs. Respondents tended to name friends whose beliefs about smoking were similar to their own, and the likelihood of being named as a friend was higher for those who reported more positive beliefs about smoking. Conclusion: The results from this study suggest that peer beliefs about smoking, in addition to peer cigarette use itself, are associated with adolescent smoking through several mechanisms. Because beliefs favorable to cigarette use are present before adolescents actually smoke, these results underscore the importance of implementing smoking prevention programs in early adolescence.     

Ethnic comparison of attitudes and beliefs about cigarette smoking

OBJECTIVE: To determine if hypothesized differences in attitudes and beliefs about cigarette smoking between Latino and non-Latino white smokers are independent of years of formal education and number of cigarettes smoked per day. DESIGN: Cross-sectional survey using a random digit dial telephone method. SETTING: San Francisco census tracts with at least 10% Latinos in the 1990 Census. PARTICIPANTS: Three hundred twelve Latinos (198 men and 114 women) and 354 non-Latino whites (186 men and 168 women), 18 to 65 years of age, who were current cigarette smokers participated. MEASUREMENTS AND MAIN RESULTS: Self-reports of cigarette smoking behavior, antecedents to smoking, reasons to quit smoking, and reasons to continue smoking were the measures. Latino smokers were younger (36.6 vs 39.6 years, p<.01), had fewer years of education (11.0 vs 14.3 years, p<.001), and smoked on average fewer cigarettes per day (9.7 vs 20.1, p<.001). Compared with whites, Latino smokers were less likely to report smoking “almost always or often” after 13 of 17 antecedents (each p<.001), and more likely to consider it important to quit for 12 of 15 reasons (each p<.001). In multivariate analyses after adjusting for gender, age, education, income, and number of cigarettes smoked per day, Latino ethnicity was a significant predictor of being less likely to smoke while talking on the telephone (odds ratio [OR] 0.41; 95% confidence interval [CI] 0.26, 0.64), drinking alcoholic beverages (OR 0.66; 95% CI 0.44, 0.99), after eating (OR 0.55, 95% CI 0.37, 0.81), or at a bar (OR 0.62, 95% CI 0.41, 0.94), and a significant predictor of being more likely to smoke at a party (OR 1.72; 95% CI 1.14, 2.60). Latino ethnicity was a significant predictor of considering quitting important because of being criticized by family (OR 1.93; 95% CI 1.26, 2.98), burning clothes (OR 1.57; 95% CI 1.02, 2.42), damaging children’s health (OR 1.67; 95% CI 1.08, 2.57), bad breath (OR 2.07; 95% CI 1.40, 3.06), family pressure (OR 1.67; 95% CI 1.10, 2.60), and being a good example to children (OR 1.83; 95% CI 1.21, 2.76). CONCLUSIONS: Differences in attitudes and beliefs about cigarette smoking between Latinos and whites are independent of education and number of cigarettes smoked. We recommend that these ethnic differences be incorporated into smoking cessation interventions for Latino smokers. Supported by Public Health Service grant CA39260 awarded by the National Cancer Institute and by grant HS07373-01 from the Agency for Health Care Policy and Research. Dr. Pérez-Stable was a Henry J. Kaiser Family Foundation Faculty Scholar in general internal medicine.     

Do E‐cigarettes induce weight changes and increase cardiometabolic risk? A signal for the future

The prevalence of non‐cigarette tobacco use in electronic cigarettes, also called vaping, is rapidly increasing, especially in adolescents and young adults, due to attractive marketing techniques promoting them as healthier alternatives to conventional tobacco cigarettes. Although smoking is associated with weight loss, it increases insulin resistance and attributes to other features of the metabolic syndrome, increasing the cardiometabolic risk profile. Whether vaping has the same deleterious effects on metabolic parameters as regular cigarette smoke has not yet been studied thoroughly in humans. However, animal model experiments attribute comparable effects of e‐cigarette smoking, even without nicotine exposure, on weight and metabolic parameters as compared to smoking cigarettes. In this review paper, we want to give an overview of published data on the effects on weight and cardiometabolic parameters of e‐cigarette use and formulate some mechanistic hypotheses.     

Cigarettes and waterpipe smoking among medical students in Syria: a cross-sectional study

OBJECTIVES: To investigate tobacco use, beliefs and attitudes among medical students in Syria. METHODS: A cross-sectional study of a random sample of 570 medical students (first and fifth year) registered at the Damascus University Faculty of Medicine in 2006-2007. We used a self-administered questionnaire for demo-graphic information, smoking behaviour (cigarette, waterpipe), family and peer smoking, attitudes and beliefs about smoking and future role in advising patients to quit smoking. RESULTS: The overall prevalence of tobacco use was 10.9% for cigarettes (15.8% men, 3.3% women), 23.5% for waterpipe (30.3% men, 13.4% women) and 7.3% for both (10.1% men, 3.1% women). Both smoking methods were more popular among the fifth year students (15.4% and 27%) compared to their younger counterparts (6.6% and 19.7%). Regular smoking patterns predominated for cigarettes (62%), while occasional use patterns predominated for waterpipes (83%). More than two thirds of students (69%) thought they might not address or would have difficulty addressing smoking in their future patients. CONCLUSION: The level of tobacco use among Syrian medical students is alarming and highlights the rapidly changing patterns of waterpipe use, especially among female students. Medical schools should work harder to tackle this phenomenon and address it more efficiently in their curricula.     

The association between seeing retail displays of tobacco and tobacco smoking and purchase: findings from a diary-style survey

Aims To assess the impact of retail displays of tobacco on tobacco smoking and purchase by smokers and attempting quitters. Design Population‐based diary style survey. Setting NSW, Australia. Participants A total of 998 smokers and 111 attempting quitters. Measurements Demographic measures and 4‐hourly records over 4 days: number of cigarettes smoked and bought; exposure to cigarette smoking by friends/family or other smokers; and exposure to retail displays of tobacco. Findings Subjects reported seeing cigarettes for sale in more than 40% of the time‐periods when they were outside their home. After allowing for factors which are known to increase smoking, people who saw cigarettes for sale were more likely to smoke, and smoked more cigarettes, even if they did not buy cigarettes in the same time‐period. There was marginally significant evidence that people exposed to retail displays of tobacco in one time‐period were more likely to buy in the following time‐period. Conclusions In an environment which permits point‐of‐sale displays, smokers were found to see tobacco displays in more than 40% of the 4‐hour periods that they were outside the home. Exposure to such tobacco displays was associated with a higher probability of smoking, and with higher levels of smoking, even when subjects did not purchase cigarettes.     

Smoking, aging and the centenarians

The smoke of cigarettes represents an important accelerator of the aging process, both directly through complex mechanisms mediated prevalently by excessive formation of free radicals, and indirectly by favoring the appearance of various pathologies in which smoke is a recognized risk factor. This means that smoke compromises not only life expectancy, but also the quality of the life, favoring the occurrence of non-autosufficiency. Smoking is an important risk factor for many diseases, such as cancer, cardiovascular and respiratory diseases. These are also the main causes of death in the industrialized Countries, where the habit of smoking is also largely diffused. Non-smokers have a much higher life expectancy than smokers, and the suspension of smoking is accompanied, even in the elderly, by an increase in the survival time due to the reduction of smoke-induced biological damage. Therefore, cigarette smoking is opposing the longevity, particularly the extreme one, as it is confirmed by the observations obtained on centenarians. Among them, smoking is extremely rare, and even when it occurs among them, it is correlated almost exclusively to bad health conditions and non-autosufficiency, indicating that it compromises health status and the quality of life even in extremely long living subjects. Considering the demonstrated beneficial effects of suspension of smoking, all practitioners and geriatricians in particular, should promote the abstinence from smoking as a behavioral norm for a correct life style. Non-smokers can delay the appearance of diseases and of the aging process, thus attaining longevity; further, non-smoking habit allows genetically predisposed subjects to reach the extreme longevity and maintain an acceptable health status and autosufficiency.     

The urge to smoke depends on the expectation of smoking

Aims An earlier study ( Dols et al. 2000 ) suggested that cue‐induced urge to smoke depends on the expectation of smoking. The present study tried to replicate the findings under stringently controlled conditions. Design A 2 (context) × 2 (cues) × 6 (trial) within‐subject design. Each smoker entered two different contexts; one context predicted the future occurrence of smoking (i.e. one puff of a cigarette) and one context predicted the non‐occurrence of smoking. In each context smokers were exposed to smoking cues (i.e. cigarettes and lighter) or not. Setting Laboratory at Maastricht University. Participants Thirty‐two daily smokers, smoking at least five cigarettes a day for at least 2 years. Measurements. Participants reported their urge to smoke in each context in the presence and absence of smoking cues using a computerized visual analogue scale (VAS). Findings The results revealed that the urge to smoke was higher in a context in which smoking was expected relative to a context in which it was not expected. As in the previous study the urge‐inducing effect of smoking cues was larger in the smoking context than in the non‐smoking context. Moreover, smoking cues did not have a significant effect in the non‐smoking context. Conclusions It was shown that smoking cues elicit craving due mainly to a generated expectation of the occurrence of smoking and less due to salience or long history of associative learning. Theoretical and practical implications of the results are discussed.     

Cigarette smoking in opioid-using patients presenting for hospital-based medical services

Little is known about cigarette smoking among opioid users who are not in substance abuse treatment. The study examined cigarette smoking in out-of-treatment opioid users presenting at a hospital who participated in drug abuse research. Participants exhibited a high rate of smoking (92%) at baseline that remained unchanged at one year and were moderately nicotine-dependent. Nineteen percent preferred unfiltered cigarettes. Women were more likely to smoke menthol cigarettes; men were more likely to smoke unfiltered cigarettes. Caucasians tended to smoke more than other ethnicities and exhibited greater dependence. Out-of-treatment drug users continue to be at high risk for continued smoking.     

Cigarettes and cigarette smoking.

Tobacco use was widespread in the New World by the time of the first voyage of Columbus; however, it is only in the last century that the use of tobacco as cigarettes has been prevalent. The milder tobacco and more acidic smoke of cigarettes lead to the deeper inhalation of tobacco into the lung with resultant deposition and absorption of the addicting, toxic, and carcinogenic components of the smoke. More than 4000 individual constituents have been identified in cigarette smoke, and the relative concentrations of these constituents vary widely between brands of cigarettes. Tar yield, a measure of the total particulate matter of the smoke, varies markedly with the characteristics of the cigarette manufacture and with the pattern of inhalation. As a result, tar is not a good measure of the dose of toxic or carcinogenic agents received by the individual smoker. The particle size of cigarette smoke is in the range that will lead to deposition in the airways and alveoli of the lung, and many of the gas-phase constituents are absorbed across the alveolar capillary membrane. The irritant agents in the smoke cause acute and chronic changes in lung structure and function that may result in greater retention of carcinogens within the lung and increased vulnerability of the lung to the effects of these carcinogens. Carcinogens and other constituents of cigarette smoke are also absorbed into the blood and metabolized to active forms through microsomal enzyme systems induced by cigarette smoke. The cellular influx of neutrophils and alveolar macrophages that is part of the inflammatory response may be the precursor of the alveolar wall destruction that results in emphysema. The prevalence of smoking is not uniformly distributed across the population. Men began smoking in large numbers very early in the century, but women began to smoke in large number only at the time of the Second World War. Men born after 1930 have been less likely to take up smoking than their older counterparts. The prevalence of smoking is currently declining in both men and women.     

Leaving work to smoke

Work-place smoking bans have not only reduced work-day cigarette consumption but also been associated with going outside to smoke during working hours. We examined the extent of "exiled smoking", estimated how much work-day cigarette consumption can be attributed to it, and examined proximal predictors of both these two variables. Some 794 smokers from 42 medium-sized work-places were surveyed as the baseline for an intervention study. A self-completed questionnaire assessed smoking behaviour on work and non-working days, leaving work to smoke, and beliefs and opinions about smoking and smoking bans. Multiple regressions were used to examine predictors of leaving work to smoke, and of the amount smoked when doing so. Smokers reported consuming an average of 5.4 cigarettes during work breaks, 3.5 of which were associated with deliberately seeking opportunities to smoke; 39% reported leaving work to smoke one or more times per day during non-break periods. Indices of addiction were significant predictors of both leaving work to smoke and of cigarette consumption while doing so. Leaving work to smoke is in part an activity of addicted smokers, presumably to maintain blood nicotine levels. There is the potential to further reduce rates of cigarette consumption associated with work-place smoking bans if this "exiled smoking" can be reduced. This may be easier to achieve in light smokers.     

Cognitive test scores in male adolescent cigarette smokers compared to non‐smokers: a population‐based study

Background Although previous studies indicate that people with lower intelligence quotient (IQ) scores are more likely to become cigarette smokers, IQ scores of siblings discordant for smoking and of adolescents who began smoking between ages 18–21 years have not been studied systematically. Methods Each year a random sample of Israeli military recruits complete a smoking questionnaire. Cognitive functioning is assessed by the military using standardized tests equivalent to IQ. Results Of 20 221 18‐year‐old males, 28.5% reported smoking at least one cigarette a day (smokers). An unadjusted comparison found that smokers scored 0.41 effect sizes (ES, P < 0.001) lower than non‐smokers; adjusted analyses remained significant (adjusted ES = 0.27, P < 0.001). Adolescents smoking one to five, six to 10, 11–20 and 21+ cigarettes/day had cognitive test scores 0.14, 0.22, 0.33 and 0.5 adjusted ES poorer than those of non‐smokers (P < 0.001). Adolescents who did not smoke by age 18, and then began to smoke between ages 18–21 had lower cognitive test scores compared to never‐smokers (adjusted ES = 0.14, P < 0.001). An analysis of brothers discordant for smoking found that smoking brothers had lower cognitive scores than non‐smoking brothers (adjusted ES = 0.27; P = 0.014). Conclusion Controlled analyses from this large population‐based cohort of male adolescents indicate that IQ scores are lower in male adolescents who smoke compared to non‐smokers and in brothers who smoke compared to their non‐smoking brothers. The IQs of adolescents who began smoking between ages 18–21 are lower than those of non‐smokers. Adolescents with poorer IQ scores might be targeted for programmes designed to prevent smoking.     

Relationships between hand‐rolled cigarettes and primary lung cancer: A Norwegian experience

Introduction: Detailed smoking history of patients developing lung cancer is rarely known, especially not for users of hand‐rolled cigarettes. In Norway, smoking hand‐rolled tobacco is still popular, accounting for one‐third of the total tobacco consume. Methods: A questionnaire‐based study revealing detailed information about tobacco consume with consecutive inclusion of all persons developing lung cancer in Southern Norway 2002–2005. Results: In this unselected population with 479 patients with newly diagnosed lung cancer, 95% had a smoking history and 88% of ever‐smokers had smoked primarily hand‐rolled cigarettes. The hand‐rolled cigarette smokers had smoked fewer cigarettes daily (15) and less pack‐years of tobacco (34) than fabricated cigarette smokers (20, P < 0.0001 and 42, P = 0.021, respectively). Smoking hand‐rolled cigarettes was considerably more frequent than expected from official sales statistics. Hand‐rolled cigarette smoking revealed an odds ratio of 13 for developing lung cancer compared with smoking fabricated cigarettes. Conclusion: In this unselected population with newly diagnosed lung cancer, nine out of 10 ever‐smokers had smoked primarily hand‐rolled cigarettes. Patients smoking hand‐rolled cigarettes had a smoking history of fewer daily cigarettes and less pack‐years tobacco consumed than fabricated cigarette smokers. In this study, hand‐rolled cigarettes are more frequently used than shown in national statistics. Smokers of hand‐rolled cigarettes may have a greatly increased risk for lung cancer compared with smokers of fabricated cigarettes. Please cite this paper as: Rolke HB, Bakke PS and Gallefoss F. Relationships between hand‐rolled cigarettes and primary lung cancer: A norwegian experience. The Clinical Respiratory Journal 2009; 3: 152–160.     

The effect of retail cigarette pack displays on impulse purchase

AIMS: To assess the extent to which point-of purchase (POP) cigarette displays stimulate impulse purchases. DESIGN: Telephone-administered population survey. SETTING: Victoria, Australia. PARTICIPANTS: A total of 2996 adults, among whom 526 smoked factory-made cigarettes and 67 were recent quitters (quit in the past 12 months). MEASUREMENTS: Reported cigarette purchase behaviour; perceived effect on smoking of removing cigarettes from view in retail outlets; reported urges to buy cigarettes as a result of seeing the cigarette display. FINDINGS: When shopping for items other than cigarettes, 25.2% of smokers purchased cigarettes at least sometimes on impulse as a result of seeing the cigarette display. Thirty-eight per cent of smokers who had tried to quit in the past 12 months and 33.9% of recent quitters experienced an urge to buy cigarettes as a result of seeing the retail cigarette display. One in five smokers trying to quit and one in eight recent quitters avoided stores where they usually bought cigarettes in case they might be tempted to purchase them. Many smokers (31.4%) thought the removal of cigarette displays from stores would make it easier for them to quit. CONCLUSIONS: POP cigarette displays act as cues to smoke, even among those not explicitly intending to buy cigarettes, and those trying to avoid smoking. Effective POP marketing restrictions should encompass cigarette displays.     

Evaluation of patients followed up in a cigarette cessation clinic

Objectives: The aim of this study was to evaluate the demographic characteristics and factors determining success in a smoking cessation clinic in smokers who completed a 1‐year follow up. Method: A total of 349 patients were assessed retrospectively. Results: There were 238 men (mean age: 41 ± 13.5 years) and 111 women (mean age: 37 ± 11.9 years) (t‐test P = 0.004). The average age at which they began to smoke, number of years of smoking and the number of cigarettes/day were 17.5 ± 5.2 years (median 17), 22.1 ± 13.3 years, 23.5 ± 12.0, respectively. Cigarette smoking was mostly observed in university graduates (56.8%) and a moderate negative correlation existed between education status and smoking duration (r = ?0.27, P = 0.000). Patients with a Fagerström Tolerance Questionnaire score of ≥6 and those exposed to cigarette smoke in childhood tended to commence and become commited smokers later in life (χ² = 4.915, P = 0.027). In all, 151 patients (43.26%) were successful in quitting (χ² = 36.4, P = 0.000). Of these, 87 (24.93%) used medication such as nicotine patches (13.5%), bupropion (7.2%), nicotine patches + bupropion (4.3%) and 64 (18.33%) refused medication, but came for professional support. Conclusion: Increased education level, behavioural therapy and intensive motivational support, follow‐up visits and phone calls all appear to play important roles in smoking cessation. Families also play a major role.     

Lipoprotein and oxygen transport alterations in passive smoking preadolescent children. The MCV Twin Study

We investigated the cardiovascular effects of lifelong passive cigarette smoke exposure in preadolescent children and examined the following questions: 1) Is systemic oxygen transport altered? 2) Are coronary heart disease risk factors adversely affected? We recruited 216 families from the MCV Twin Study; 105 had at least one smoking parent. Serum thiocyanate and cotinine levels were used as measures of smoke exposure in the children and thiocyanate was proportional to the number of parental cigarettes smoked each day (p = 0.0001). Paternal smoking had no effect on these measures. Whole blood 2,3-diphosphoglycerate was higher in smoke-exposed than unexposed children (p less than 0.01) and was related to the thiocyanate level (p less than 0.02). High density lipoprotein (HDL) cholesterol was lower in passive smoking children (p less than 0.05); the HDL2 subfraction was reduced in passive smoking boys, while the HDL3 subfraction was reduced in passive smoking girls. Significant adverse alterations in systemic oxygen transport and lipoprotein profiles are already present in preadolescent children exposed to long-term passive cigarette smoke, primarily from maternal smoke. Children with long-term exposure to passive smoke may be at elevated risk for the development of premature coronary heart disease.     

Australian smokers' and recent quitters' responses to the increasing price of cigarettes in the context of a tobacco tax increase

Aims To track smokers' responses to the increasing price of cigarettes after a tax increase, and assess socio‐demographic differences in responses. Design The Cancer Institute NSW's Tobacco Tracking Survey (CITTS) is a continuous tracking telephone survey. Weekly data were collected between May and September 2010. Settings New South Wales, Australia. Participants A total of 834 smokers and 163 recent quitters (quit in last 12 months). Measurements Responses to the price increase included smoking‐related changes (tried to quit, cut down) and product‐related changes (changed to lower priced brands, started using loose tobacco, bought in bulk). Recent quitters were asked how much the increasing price of cigarettes influenced them to quit. Findings Overall, 47.5% of smokers made smoking‐related changes and 11.4% made product‐related changes without making smoking‐related changes. Multinomial logistic regressions showed that younger smokers (versus older) were more likely to make product‐related changes and smoking‐related changes in comparison to no changes. Low‐ or moderate‐income smokers (versus high‐income) were more likely to make smoking‐related changes compared to no changes. Highly addicted smokers (versus low addicted) were more likely to make product‐related changes and less likely to make smoking‐related changes. The proportion of smokers making only product‐related changes decreased with time, while smoking‐related changes increased. Recent quitters who quit after the tax increase (versus before) were more likely to report that price influenced them. Conclusions The effect of increasing cigarette prices on smoking does not appear to be mitigated by using cheaper cigarette products or sources. These results support the use of higher cigarette prices to encourage smoking cessation.     

The impact of cigarette deprivation and cigarette availability on cue–reactivity in smokers

Aims This experiment was conducted to determine the impact of cigarette deprivation and cigarette availability on reactivity measures to cigarette cues. Participants Smokers were recruited who were 18 years of age or older, not attempting to quit or cut down on their smoking, smoked at least 20 cigarettes daily, had been smoking regularly for past year and had an expired carbon monoxide level of at least 10 parts per million. Design Smokers were assigned randomly to abstain from smoking for 24 hours (n = 51) or continue smoking their regular amount (n = 50). Twenty‐four hours later, they were exposed to trials of either a lit cigarette or a glass of water with a 0, 50 or 100% probability of being able to sample the cue on each trial. Craving, mood, heart rate, skin conductance, puff topography and latency to access door to sample the cue were measured. Findings Both exposure to cigarette cues and increasing availability of those cues produced higher levels of craving to smoke. Deprivation produced a generalized increase in craving. There was no consistent evidence, however, that even under conditions of high cigarette availability, deprived smokers were sensitized selectively to presentations of cigarette cues. Conclusions The data suggest that, even under conditions of immediate cigarette availability, deprivation and cue presentations have independent, additive effects on self‐reported craving levels in smokers.     

Pharmacokinetic Predisposition to Nicotine from Environmental Tobacco Smoke: A Risk Factor for Pediatric Asthma

During the last decade several studies have shown that children whose parents smoke have higher rates of asthma. Recently, hair concentrations of cotinine have been shown to reflect systemic exposure to this constituent of smoke in both children and adults. At the present time it is not known, however, why some children exposed to passive smoking have asthma while others, similarly exposed, do not. The present study aimed at verifying whether asthmatic children are different from nonasthmatic children exposed to similar degrees of passive smoking in the way their bodies handle nicotine, a constituent of cigarette smoke. Seventy-eight asthmatic children were compared to 86 control children, all attending a consulting pediatric clinic in Toronto. A questionnaire completed by the parents and children detailed the daily number of cigarettes the child was exposed to and the identity of the smokers. Clinical data were extracted from the patients' charts. Urinary (corrected for creatinine) and hair concentrations of cotinine were measured by radioimmunoassays. The asthmatic and control children were of similar age, gender, and ethnic distribution, parental education, and socioeconomic status. Parents of asthmatic children tended to report a lower daily number of cigarettes (7.4 ± 1.3/day vs. 11.2 ± 2.3/day, p = 0.14), and this report agreed with the trend of urinary cotinine (47.1 ± 9.1 ng/mg vs. 62.6 ±11.5 ng/mg, respectively). Conversely, children with asthma had on average twofold higher concentrations of cotinine in their hair (0.696 ± 0.742 ng/mg) than control children (0.386 ± 0.383) (p = 0.0001). In a similar manner, the hair.urine concentration ratio was significantly higher in children with asthma (0.028 ± 0.002) than in their controls (0.18 ± 0.003) (p = 0.0001). These results suggest that under exposure to similar amounts of nicotine, children with asthma have on average twofold higher systemic exposure to this constituent of cigarette smoke. These data suggest that out of all children passively exposed to environmental tobacco smoke, those who exhibit asthma have a higher systemic exposure to nicotine, possibly due to lower clearance rate. This is the first evidence of pharmacokinetic predisposition to environmental tobacco smoke as an etiological factor in pediatric asthma.     

Passive smoking as an independent risk factor for gestational diabetes that synergizes with prepregnancy obesity in urban Chinese women

There are high‐priority public health and legislative efforts around the world to reduce smoking and to reduce the spaces where smoking is allowable. These efforts are aimed at minimizing not only the adverse health effects of active smoking but also the adverse health effects of passive cigarette smoke exposure. While many cultures and societies make protection of a pregnant woman and her about‐to‐be‐born‐newborn a priority, the importance of protecting them from passive smoking that is prevalent in many modern societies has not been reported. The article by Leng et al, “Passive smoking increased risk of gestational diabetes mellitus independently and synergistically with prepregnancy obesity in Tianjin, China,” newly published in Diabetes Metabolism Research and Reviews , provides evidence that passive smoke inhalation during pregnancy makes gestational diabetes more likely, bringing with it negative health consequences for the mother and her baby. This study will hopefully add support to public health officials' efforts to curb cigarette use, especially in public domains.