Cigarette smoking and body weight in the Cancer Prevention Study I.

To investigate the generality of the association of heavy cigarette smoking with increased body weight, the relation of number of cigarettes smoked per day to relative body weight was examined in baseline data for 891,589 participants in a prospective study initiated in 1959. Although the relative weight of cigarette smokers was consistently lower than that of never and exsmokers, men and women smoking two or more packs of cigarettes per day were more likely to be categorized as moderately or severely overweight and less likely to be categorized as underweight than those smoking 10-20 cigarettes per day, despite somewhat greater educational attainment by heavier smokers. These analyses offer support for the temporal generality of the relation between heavier cigarette smoking and greater body weight, and suggest that this phenomenon cannot be explained by historic trends in the socioeconomic stratification of smoking prevalence or smoking dose.     

Cigarette consumption by individuals in Malaysia: a zero-inflated ordered probability approach

Aim

To investigate cigarette consumption patterns exhibited by non-smokers, occasional smokers, and daily smokers in Malaysia.

Subjects and methods

A sample of 4204 individuals from the 2011 Malaysian Global Adult Tobacco Survey is analyzed. A zero-inflated ordered probit model is used to accommodate the ordinal nature of smoking outcomes with excessive zero observations of non-smokers.

Results

Socio-demographic characteristics are closely associated with consumption patterns of non-smokers, occasional smokers, and daily smokers. Specifically, urbanites, government employees, and Malays exhibit greater tendencies to be daily smokers and lower propensities to be non-smokers than others. Education is a deterring factor in cigarette smoking as higher education up to the tertiary level raises the propensity of being a non-smoker by 8.16 percentage points. The role of ethnicity is highlighted as individuals of Malay and other ethnic backgrounds are more likely to smoke daily, while exhibiting lower propensities of being non-smokers. Males are more likely to engage in occasional or daily smoking than females. Employment in government or non-government sectors increases the probability of daily smoking.

Conclusions

Our results suggest the need to include measures to cope with internal or external cues among smokers with specific socio-demographic characteristics. Cessation interventions should focus on daily smokers in urban surroundings with low education levels and those of Malay ethnic origins. Anti-smoking measures in line with occasional smoking may include ameliorating the male attitude toward smoking and policies to prohibit workplace indulgence.

     

Gender differences in the relationship between physical activity and smoking among psychiatrically hospitalized adolescents

Physical activity has been identified as a protective factor with regard to tobacco use, such that physically active adolescents are less likely to initiate smoking, and smokers are less physically active than non-smokers. These findings, along with the well-documented benefits of exercise on mood and well-being in adults, have stimulated interest in exercise-based smoking cessation interventions. However, little research has explored the relationship between physical activity and smoking characteristics within adolescent smokers. Also, gender differences in adolescents' motives for smoking and exercise may have implications for intervention development, especially in clinical populations. The current study explored the relationship between physical activity and smoking in a sample of adolescent smokers (N = 191) and non-smokers (N = 48) receiving inpatient psychiatric treatment (61% female, mean age 15.3 years). Results indicated that smokers were less likely to be physically active than non-smokers. Additionally, there was a consistent pattern of gender differences in the relationship between smoking and physical activity within smokers. Specifically, physically active male smokers were less nicotine dependent and less prone to withdrawal symptoms, and had a trend toward greater motivation to quit, than their non-active counterparts. In contrast, physically active female smokers did not differ in dependence or withdrawal and were less motivated to quit than non-active female smokers. Taken together, these results suggest that within clinical populations of adolescent females, smoking and exercise may be used jointly as weight control strategies. Exercise-based interventions for smoking cessation for adolescent females, especially clinical populations, should address weight and body image concerns.     

Food and nutrient intake differences between smokers and non-smokers in the US.

Data from the Second National Health and Nutrition Examination Survey were analyzed to determine food and nutrient intake differences between current smokers (also categorized as light, moderate, and heavy smokers) and non-smokers. Smokers in several age-race-sex categories have lower intakes of vitamin C, folate, fiber, and vitamin A than non-smokers, and intake tended to decrease as cigarette consumption increased, particularly for vitamin C, fiber, and folate. Smokers were less likely to have consumed vegetables, fruits (particularly fruits and vegetables high in vitamins C and A), high fiber grains, low fat milk, and vitamin and mineral supplements than non-smokers. A negative linear trend was found between smoking intensity and intake of several categories of fruits and vegetables. These data suggest that the high cancer risk associated with smoking is compounded by somewhat lower intake of nutrients and foods which are thought to be cancer protective.     

Smoking prevalence and attitudes of Gwynedd Health Authority staff towards passive smoking and the Authority's non-smoking policy

In 1989, a postal survey was undertaken to investigate the smoking prevalence and attitudes of Gwynedd Health Authority employees towards the Authority's non-smoking policy, passive smoking and other related issues. The results show a smoking prevalence rate of 22% for those participating in the survey, with over half of all smokers expressing a wish to stop. Although the rate was similar for males and females, it was marginally higher amongst nursing staff and young employees. Smoking prevalence was highest among the ancillary staff, and lowest among the medical and dental professions. Most employees were in broad agreement with the Authority's non-smoking policy, and a majority thought it about right or favoured extending it. Most non-smokers and ex-smokers believed passive smoking to be a health hazard, with an increased number rating it anti-social. Attitudes towards these issues were similar for males and females, with marked differences between the groups employed in different areas of the service. Younger employees were more aware of the dangers of passive smoking, but less sympathetic towards the policy than the older ones. The findings of this study highlight the differences between smokers and non-smokers on all smoking issues. The implications for health education and the Authority's non-smoking policies are discussed.     

A comparative evaluation of a restrictive smoking policy in a general hospital.

The impact of a restrictive smoking policy on the behavior and attitudes of smokers and non-smokers was assessed by surveying random cross-sectional samples of hospital employees before, six months after and 12 months after the policy was implemented, and comparing responses with those of employees of a hospital with no restrictive policy. Effectiveness of policy implementation was also evaluated. Results indicated that the policy was well-publicized and was approved by virtually all the non-smokers and the majority of the smokers. Following implementation, employees in the smoking policy hospital were less likely to report being bothered by smoke at their work stations than were employees of the comparison hospital. Six months and one year after the policy change, smokers reported lower smoking rates while at work, although quit smoking rates and home smoking rates were similar in both hospitals.     

Does the association between smoking and mortality differ by educational level?

Some researchers suggest that the effect of smoking on health depends on socioeconomic status; while others purport that the effect of smoking on health is similar across all social groups. This question of the interaction between smoking and socioeconomic status is important to an improved understanding of the role of smoking in the social gradient in mortality and morbidity. For this purpose, we examined whether educational level modifies the association between smoking and mortality. Information on smoking by age, gender and educational level was extracted from the Belgian Health Interview Surveys of 1997 and 2001. The mortality follow up of the survey respondents was reported until December 2010. A Poisson regression was used to estimate the hazard ratio of mortality for heavy smokers, light smokers, and former smokers compared with never smokers by educational level controlling for age and other confounders. Among men, we found lower hazard ratios in the lowest educational category compared with the intermediate and high-educated categories. For instance, for heavy smokers, the hazard ratios were 2.59 (1.18-5.70) for those with low levels of education, 4.03 (2.59-6.26) for those with intermediate levels of education and 3.78 (1.52-9.43) for the highly educated. However, the interaction between smoking and education was not statistically significant. For women, the hazard ratios were not significant for any educational category except for heavy smokers with intermediate levels of education. Also here the interaction was not statistically significant. Our results support the hypothesis that educational attainment does not substantially influence the association between smoking and mortality.     

Demographic and socioeconomic differences in beliefs about the health effects of smoking.

To assess sociodemographic differences in beliefs about the health effects of cigarette smoking and passive smoke exposure, we recently surveyed 2092 adults in St. Louis and Kansas City, Mo. The percentages of respondents who knew that smoking causes lung cancer, emphysema, and heart disease were 76.7, 74.1, and 67.2, respectively. After multivariate adjustment, knowledge about smoking's health effects was generally lower among women, older respondents, those of lower education level, and current smokers. Blacks were generally less likely to appreciate the health effects of active smoking, but were more likely to acknowledge the health effects of passive smoking.     

Support for population level tobacco control policies in Hungary

Background: Smoking is the leading, preventable risk factor for premature death and disability in Hungary. The objective of this paper was to assess the social acceptability of and the predictors of holding favourable attitudes toward tobacco control policies among the Hungarian population. Methods: A self-administered questionnaire-based study was carried out among individuals aged 16-70 years. Logistic regression analysis was used to assess whether support for the ten tobacco control policies varies as a function of age, sex, educational level, and smoking status. Results: The majority of the respondents supported the studied tobacco control measures. Over 90 percent of the sample supported: fines for retailers selling tobacco products to minors (92.3%), stricter enforcement of restrictions on selling tobacco products to minors (90.5%), and a ban on smoking in health care institutions (91.4%). The lowest levels of support were for bans on sponsorship by the tobacco industry (52.8%) and price increases on tobacco products (54.9%). For each measure, support was significantly lower among smokers than non-smokers. Age and education were significantly related to support for some but not all measures. Conclusions: Strong majorities of Hungarians support the enactment and enforcement of a wide range of tobacco control measures, a fact that was acknowledged by Parliament's passage of the 2011 Anti-Smoking Law. Advocacy efforts to encourage the acceptance of tobacco control policies should focus not only on smokers, but also on younger and less educated non-smokers.     

北京市居民烟草危害相关知识及正向社会认知调查

目的了解北京市居民对烟草健康危害相关知识的知晓情况和正向社会认知的情况。方法 2007年12月在北京市朝阳区两个社区中采用方便抽样的方法选择居民,并使用自制调查问卷进行调查。结果本调查共收到有效调查问卷536份。按调查对象是否吸烟进行分层分析,均显示非吸烟者对吸烟健康危害知识和正向社会认知的正确回答率和认知率高于吸烟者(P0.05)。结论居民对烟草危害具有一定的认识,但是吸烟者和非吸烟者的认识水平存在较大差异,还需要加强宣传教育,其中吸烟者是未来开展教育活动的重点人群。     

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.     

Depressive symptoms and cigarette smoking among Native Hawaiians

The present study estimated the prevalence of depressive symptoms and cigarette smoking and examined the relationship between depressive symptoms and cigarette smoking among native Hawaiians. Cross-sectional data from 524 rural, native Hawaiian from the Native Hawaiian Health Research Project are presented. Depressive symptoms were measured using the self-report Centre for Epidemiological Studies--Depression Scale. Information on smoking behavior and sociodemographic variables was collected. The prevalence of depressive symptoms was 15%, and significantly higher among participants with lower educational attainment. The prevalence of current smokers was 32%, and significantly higher among younger adults and participants with lower educational attainment. Regression analyses reported a significant relationship between CES-D scores and smoking status as well as between CES-D scores and number of cigarettes smoked daily. However, when education and age were included in the regression models, the relationships were attenuated. The findings and implications of this study are discussed.     

Co-occurring obesity and smoking among U.S. women of reproductive age: Associations with educational attainment and health biomarkers and outcomes

IntroductionObesity and smoking are independently associated with socioeconomic disadvantage and adverse health effects in women of reproductive age and their children, but little is known about co-occurring obesity and smoking. The purpose of this study was to investigate relationships between co-occurring obesity and smoking, socioeconomic status, and health biomarkers and outcomes in a nationally representative sample.MethodsData from non-pregnant women of reproductive age were obtained from the U.S. National Health and Nutrition Examination Surveys reported between 2007 and 2010. Linear and logistic regressions were used to examine associations between obesity and smoking alone and in combination with educational attainment and a range of health biomarkers and outcomes.ResultsPrevalence of co-occurring obesity and smoking was 8.1% (~ 4.1 million U.S. women of reproductive age) and increased as an inverse function of educational attainment, with the least educated women being 11.6 times more likely to be obese smokers than the most educated. Compared to women with neither condition, obese smokers had significantly poorer cardiovascular and glycemic biomarker profiles, and higher rates of menstrual irregularity, hysterectomy, oophorectomy, physical limitations, and depression. Obese smokers also had significantly worse high-density lipoprotein (HDL) cholesterol levels, physical mobility, and depression scores than those with obesity or smoking alone.ConclusionsCo-occurring obesity and smoking is highly associated with low educational attainment, a marker of socioeconomic disadvantage, and a broad range of adverse health biomarkers and outcomes. Interventions specifically targeting co-occurring obesity and smoking are likely necessary in efforts to reduce health disparities among disadvantaged women and their children.     

The outcome of infertility treatment by in-vitro fertilisation in smoking and non-smoking women

The former and current smoking habits of 159 patients treated for infertility by means of IVF/ET technique were observed. The data were verified by a cotinine examination in urine. The basal levels of gonadotropines before treatment, the process and outcome of ovarian stimulation, oocyte fertilisation and incidence of pregnancy were observed. There were no differences between smokers and non-smokers in terms of their age and professional risks; smoking correlated with a lower level of education. The overall response of active smokers to hormonal stimulation was worse than that of non-smokers: a lower number of mature follicles (12.3 vs. 16.2) and a lower number of oocytes were gained (7.3 vs. 10.9). There was a correlation between the age of the smokers and the higher consumption of FSH needed for stimulation and lower levels of 17 beta-estradiole. The number of fertilised oocytes in smokers was significantly lower (p < 0.01; 68.2% vs. 47.8%). A negative correlation between the duration of exposure to cigarette smoke and fertilisation rate was shown (p < 0.05). There were fewer embryos in smokers as compared with non-smokers (3.3 vs. 4.7). A total of 35 women became pregnant (i.e. 22.1%), of which 28.8% were non-smokers, 12.5% were occasional smokers, and none were regular smokers. The OR value in non-smokers was 1.48, and in occasional smokers 0.57. In this study, the negative influence of smoking on the outcome of treatment by IVF/ET technique was proved. The phasing out of smoking should be an integral part of human infertility treatment.     

Some social background variables among smoking and non-smoking primiparae

Of a population of 2,427 Norwegian primiparae, 62.7% were non-smokers, 23.0% smoked fewer than 10 cigarettes a day, and 14.3% smoked 10 or more a day. There was a significant correlation between smoking in pregnancy and age below 20 years, unmarried or previously married status, and poor education (p less than 0.001). Poor housing is of less importance. The mean age of smokers (24.0 years) was significantly lower than that of non-smokers (25.8 years) (p less than 0.001). The overall incidence of smoking in pregnancy was not significantly different from that in the normal population, but pregnant women under 20 smoked significantly more and those older than 24 significantly less, compared with their counterparts in a normal population (p less than 0.01).     

Stage of change is associated with assessment of the health risks of maternal smoking among pregnant women

This study explored pregnant women's assessment of the health risks associated with maternal smoking. The aim was to determine if stage of change relating to smoking is associated with risk assessment. A cross-sectional survey (employing a self-completion questionnaire) was conducted of all women who attended antenatal clinics at Leicester Royal Infirmary, National Health Service Trust, UK over a 2 week period. Questionnaires were completed by 254 respondents. Twenty seven percent of non-smokers agreed with more than 75% of a series of statements about the dangers of maternal smoking compared to 5% of smokers and 44% of women in social class I (highest social class) agreed with more than 75% of the statements compared with only 10% of women in social classes IV and V (lower social class groups). Married women were twice as likely to concur with more than 75% of the health risks compared to single or cohabiting women and 29% of women intending to breastfeed agreed with more than 75% of the statements compared with only 8.7% of women not intending to breastfeed. There was no significant effect of age, whether the pregnancy was planned, previous obstetric complications or whether the woman had a child with asthma or respiratory infections. A multiple regression analysis indicated that smokers were much less likely to agree with the health risks than their non-smoking counterparts (p = 0.034). Stage of change was related to both the number of health risks agreed with and the level of conviction. A woman's stage of change could be assessed at the start of antenatal care so that appropriate smoking cessation advice can be offered.     

Health education pamphlets about smoking--their benefit to smokers and non-smokers

The aim of this present study was to compare the use by smokers and non-smokers of pamphlets about smoking as delivered from different settings. The study was a nation-wide cross-sectional survey of 1924 randomly selected, Danish men and women, aged 14-77 y, who had answered a mailed questionnaire in 1994. Of these 71% also participated in a telephone interview enquiring about the use of health education material, smoking status and socio-demographic variables, 39% of readers of household-delivered anti-smoking pamphlets reported having gained information from them and 22% reported having made changes in their own smoking behaviour such as avoiding smoking in the presence of non-smokers. In general practice settings, these percentages were higher among smokers. Smokers who were thinking of stopping smoking in the near future were in addition more likely to take and to read smoking related health education materials from other places. Non-smokers received (3 49%) and read pamphlets about smoking as frequently as did smokers who did not intend to quit. In conclusion, written health education material was well received by readers, but, when distributed in a more open setting it needs to be targeted towards smokers who are considering stopping smoking. In general practice, smokers not thinking of stopping were open to health education, and pamphlets used in this setting should also target this group. Non-smokers contribute indirectly to smokers quitting by providing support to smokers and pamphlets for non-smokers need to be more targeted towards this social role.     

An evaluation of efficacy of cigarette smoking cessation in preventing low levels of serum high-density lipoprotein (HDL) cholesterol

Correlation of serum high-density lipoprotein cholesterol (HDL-C) with cigarette smoking and alcohol consumption habit was investigated in 562 male office workers aged 31 to 60 yr. HDL-C concentrations were found to be positively associated with alcohol consumption in subjects with relative weight below 10%, but a positive association was not observed in obese subjects having relative weight of 10% or above. In contrast, HDL-C levels were significantly lower in smokers than in non-smokers regardless of obesity. The effectiveness of smoking cessation in preventing low levels of serum HDL-C was estimated by comparing prevalence rates of HDL-C levels lower than an arbitrarily determined HDL-C cutoff value in smokers with those in non-smokers. The estimation was made with unadjusted subjects and also with subjects adjusted for age, relative weight and alcohol consumption. The effectiveness was found to be considerably high in heavy smokers having lower HDL-C levels (less than or equal to 35 mg/dl) with or without hypercholesterolemia (greater than or equal to 220 mg/dl) and further remarkably high in all smokers having hypertriglyceridemia (greater than or equal to 300 mg/dl) besides lower HDL-C levels. It is therefore expected that health education focused on stopping smoking can produce favorable alterations in HDL-C for preventing coronary heart disease, especially in heavy smokers having low serum HDL-C levels concomitant with hypercholesterolemia and/or hypertriglyceridemia.     

A population survey in Ontario regarding restrictive measures on smoking: relationship of smoking status to knowledge, attitudes and predicted behaviour

A population survey of Ontario residents regarding knowledge of the health effects of smoking, attitudes towards restrictive measures, and predicted behaviour was carried out. Telephone responses of 490 current, 290 former, and 581 never smokers were compared. For both active and passive smoking, never smokers were most knowledgeable about health effects, former smokers being less knowledgeable, and current smokers least so. While a majority of each smoking status group supported some restriction on smoking in all 13 settings examined, there were consistent differences among the groups as to degree. Never and former smokers were in close agreement and were more restrictive in their attitudes than current smokers. Prohibition was more strongly favoured by all groups for health and day care facilities, schools, stores, and local transit systems than for other settings. While a majority of smokers thought there would be compliance with restrictions, non-smokers were less optimistic. Smokers were less likely than non-smokers to see a role for governments in enactment; municipal involvement was favoured over other levels by all groups. No group indicated much support for enforcement by police. These findings remained when multivariate analyses controlling for inter-group differences in sociodemographic characteristics were carried out.