Smoking habits in relation to reproductive events among Japanese women: Findings of the Japanese Nurses' Health Study

Objective

The purposes of this study were to examine smoking habits in relation to the reproductive events of pregnancy and menopause and clarify the reasons for smoking cessation among ex-smokers.

Method

This is a cross-sectional study based on a baseline survey of a prospective cohort study. From 2001 to 2007, a self-administered questionnaire survey was conducted on 49,927 female nurses from all 47 prefectures in Japan. Logistic regression models were used to estimate age-adjusted odds ratios.

Results

Of the respondents, 17.2% were current smokers, 11.6% were ex-smokers and 69.8% had never smoked. The prevalence of smoking during pregnancy was 7.8%. Among ex-smokers, 30.3% gave “reproductive events” as their reason for smoking cessation. Current smoking and the number of cigarettes smoked per day before menopause were significantly related to onset of menopause.

Conclusion

Women's smoking habits have mutual relationships with reproductive events such as pregnancy and menopause. Although “reproductive events” were an important reason for smoking cessation among women, 7.8% of women still smoked during pregnancy. Smoking was correlated with onset of menopause. Support for smoking cessation is an important healthcare issue throughout women's lifetimes.     

A multicentre randomized trial of combined individual and telephone counselling for smoking cessation

Objective

The present study assessed the effectiveness of smoking cessation programs combining individual and telephone counselling, compared to individual or telephone counselling alone.

Method

A randomized, multicentre, open-label trial was performed between January 2009 and July 2011 at six smoking cessation clinics in Spain. Of 772 smokers assessed for eligibility, 600 (77%) met inclusion criteria and were randomized. Smokers were randomized to receive individual counselling, combined telephone and individual counselling, or telephone counselling. The primary outcome was biochemically validated continuous abstinence at 52 weeks.

Results

The 52-week abstinence rate was significantly lower in the telephone group compared to the combined group (20.1% vs. 29.0%; OR, 1.32; 95% CI, 1.1–2.7) and to the individual counselling group (20.1% vs. 27.9%; OR, 1.37; 95% CI, 1.0–2.8). The 52-week abstinence rates were not significantly higher in the combined group than the individual group (OR, 0.97; 95% CI, 0.7–1.4).

Conclusion

Individual counselling and combined individual and telephone counselling were associated with higher 52-week abstinence rates than telephone counselling alone. A combined approach may be highly useful in the clinical treatment of smokers, as it involves less clinic visits than individual counselling alone, thus reducing the program cost, and it increases patient compliance compared to telephone counselling alone.     

Efectividad de un programa multicomponente para dejar de fumar aplicado en atención primaria

Objective

To evaluate the effectiveness of a multicomponent program applied by nurses in primary care.

Method

A non-experimental pre-post study was carried out in 145 smokers from Area V of Asturias (Spain). The intervention consisted of a multicomponent group treatment program, applied for 7 weeks by primary care nurses.

Results

The mean age was 52 years. Men accounted for 39.73% of the study population. The abstinence rate at post-treatment was 51.1% (95% CI: 42.4 to 59.6). At 12 months, the abstinence rate was 41.1% (95% CI: 32.6 to 49.6). The change between the end of the intervention and follow-up at 6 and 12 months was statistically significant at both time points (p = 0.035 and p = 0.013, respectively). Among participants who had stopped smoking, there was a statistically significant decline in daily cigarette consumption. Factors that were statistically significantly associated with continued smoking at 12 months were heavier smoking before the intervention, higher scores on the Fagerström test, and a lower number of sessions attended.

Conclusions

The multicomponent treatment program was highly effective. The results suggest the desirability of specific training for health professionals to implement this type of intervention in primary care as an alternative to medical advice for smokers who need it.     

Tobacco Price Increase and Smoking Cessation in Japan,a Developed Country With Affordable Tobacco: A National Population-Based Observational Study

Background

Longitudinal assessment of the impact of tobacco price on smoking cessation is scarce. Our objective was to investigate the effect of a price increase in October 2010 on cessation rates according to gender, age, socioeconomic status, and level of tobacco dependence in Japan.

Methods

We used longitudinal data linkage of two nationally representative studies and followed 2702 smokers for assessment of their cessation status. The odds ratios (ORs) for cessation were calculated using logistic regression. To estimate the impact of the 2010 tobacco price increase on cessation, data from 2007 were used as a reference category.

Results

Overall cessation rates significantly increased from 2007 to 2010, from 3.7% to 10.7% for men and from 9.9% to 16.3% for women. Cessation rates were 9.3% for men who smoked 1–10 cigarettes per day, 2.7% for men who smoked 11–20 cigarettes per day, and 2.0% for men who smoked more than 20 cigarettes per day in 2007. These rates increased to 15.5%, 10.0%, and 8.0%, respectively, in 2010. The impact was stronger among subjects who smoked more than 11 cigarettes per day than those who smoked 1–10 cigarettes per day in both sexes: ORs for 2010 were 4.04 for those smoking 11–20 cigarettes per day, 4.26 for those smoking more than 20 cigarettes per day, and 1.80 for those smoking 1–10 cigarettes per day in the main model in men. There were no obvious differences in the relationship between tobacco price increase and smoking cessation across age and household expenditure groups.

Conclusions

The tobacco price increase in Japan had a significant impact on smoking cessation in both sexes, especially among heavy smokers, with no clear difference in effect by socio-demographic status.Key words: tobacco price increase, smoking cessation, Japan, linkage study     

Prevalence of smoking and second-hand smoke exposure: differences between Spanish and immigrant pregnant women

Objectives

To identify differences in the prevalence of smoking and second-hand smoke exposure between Spanish and immigrant pregnant women, as well as the factors associated with continued smoking during pregnancy.

Methods

An epidemiologic cross-sectional study was carried out in women attended at delivery in Zaragoza (Spain). A smoking questionnaire was used to collect the following variables: the women's and partners’ sociodemographic factors and smoking behavior, second-hand smoke exposure and perception of the risks of this exposure.

Results

We included 2440 women (35% immigrants). A total of 31.1% smoked before becoming pregnant and 18.2% during pregnancy, with significant differences between Spanish and immigrant women (21.9% versus 8.7%; p < 0.001). Immigrant women lived with a greater number of smokers, smoked more inside the home, were exposed to second-hand smoke for a greater number of hours per day, avoided public places with second-hand smoke less, and more often worked in bars and restaurants. The following factors were associated with smoking during pregnancy: being Spanish, smoking a greater number of cigarettes before pregnancy, being exposed to second-hand smoke at home for a greater number of hours, having a low perception of risks and having a partner with lower educational attainment.

Conclusions

The prevalence of smoking is higher among Spanish pregnant women than immigrant women, although the immigrant population is more exposed to second-hand smoke at home and at work. There are socio-cultural differences that should be taken into account when carrying out interventions in women of reproductive age.     

Association between serum concentrations of persistent organic pollutants and smoking in Koreans: A cross-sectional study

Background

Studies on the associations between persistent organic pollutants (POPs) and smoking according to gender and smoking amount (cigarettes/day) are limited, and the results regarding the relationship between POPs and smoking are not completely consistent across studies.

Analysis of smoking cessation beliefs in pregnant smokers and ex-smokers using the Theory of Planned Behavior

Aim

To analyze the association between smoking cessation beliefs and smoking status, and between smoking cessations beliefs and intention to quit, using the Theory of Planned Behavior (TPB).

Subjects and methods

An observational study using a questionnaire was performed; data were collected from 264 Flemish pregnant smokers and ex-smokers before week 16 of pregnancy.

Results

There was a significant difference in the behavioral beliefs of the TPB between smokers and ex-smokers, after controlling for education and age. All respondents experienced more support from their non-smoking partners to maintain abstinence during pregnancy. We found no significant difference in the behavioral beliefs of the TPB between respondents with low and high intention to quit smoking.

Conclusion

Our results suggest that attitude, subjective norms, support especially from the partner, and perceived behavioral control are associated with actual smoking behavior in pregnant women and not with intention to quit smoking. It is important to engage the partner and/or significant others in smoking cessation counselling so that they can support the pregnant woman in an attempt to quit or to maintain abstinence.

     

Social Determinants of Smoking Behavior: The Healthy Twin Study,Korea

Objectives

The purpose of this study was to identify any influence of socioeconomic status on smoking and smoking cessation in a situation where genetic factors are controlled.

Methods

The sample for this study was 2502 members of the twins and families cohort who participated in the Korean Healthy Twins Study from 2005 to 2009. Groups of brothers or sisters, including twins and fraternal twins, were compared in terms of smoking and smoking cessation behaviors according to differences in socioeconomic status and gender.

Results

In a situation with complete control of genetic factors, results showed that the daily smoking amount, cumulative smoking amount, and dependence on nicotine decreased with higher-status occupations, and the rate of smoking and amount of cumulative smoking decreased with higher levels of education. Regarding smoking cessation behavior, a higher level of education was associated with a lower smoking cessation rate, and no significant gender differences were found.

Conclusions

Environmental factors had a stronger influence on smoking behavior than did genetic factors. Genetic factors had greater influence on smoking cessation than did environmental factors; however, this requires verification in further studies.     

Cardiovascular risk profile of mothers of a Portuguese birth cohort: A survey 4 years after delivery

Objectives

The aim of this study is to estimate the prevalence of smoking, low fruit and vegetable intake, sedentariness, overweight/obesity, abdominal obesity, hypertension, dyslipidemia and diabetes mellitus in mothers of a Portuguese birth cohort, 4 years after delivery.

Methods

A birth cohort was assembled at public maternities of Porto (2005–2006). Children and mothers were reevaluated 4 years later. In this analysis, 5435 women were included. Socioeconomic characteristics, smoking, diet and exercise were self-reported. Anthropometrics and blood pressure were measured. A subgroup of 2483 randomly selected women provided a fasting venous blood sample for lipid and glucose measurements.

Results

Overall, 25.3% women smoked, 71.5% consumed < 5 portions of fruit and vegetables per day, 81.3% were sedentary, 31.4% were overweight, 21.3% obese and 31.8% had abdominal obesity. The prevalence of hypertension, dyslipidemia and diabetes mellitus was 8.7%, 18.5% and 0.9%, respectively. At least one risk factor from each of the 3 groups (adverse lifestyles, adiposity and cardiometabolic comorbidities) was observed in 17.4% of women. Except for smoking, all risk factors were associated with unemployment, lower education and lower income.

Conclusions

The high prevalence of unfavorable lifestyles and adiposity, and the aggregation of risk factors emphasize the adverse cardiovascular risk profile at a young age.     

Variabilidad en el consumo de cigarrillos según la fuente de información en España (1993-2009)

Objectives

To assess the variability in the number of cigarettes smoked per person per day in Spain according to the information source (health surveys versus legal sales).

Methods

We compared cigarette consumption per person per day (population aged ≥16 years) obtained from the national health surveys in Spain and the official data on legal tobacco sales between 1993 and 2009.

Results

Cigarette consumption per person per day decreased between 1993 and 2009. Over the entire period, the number of cigarettes smoked per person per day according to legal sales exceeded that reported by national health surveys (up to 46.9%).

Conclusion

The difference in data on the number of cigarettes smoked between national health surveys and legal sales has increased in the last few years in Spain.     

Contingency Management Versus Psychotherapy for Prenatal Smoking Cessation: A Meta-Analysis of Randomized Controlled Trials

Objectives

Prenatal smoking is the leading preventable cause of poor obstetric outcomes, yet treatment options are limited. Past reviews of prenatal smoking cessation have often grouped all counseling into a single category, which ignores the fact that psychotherapy is distinct from brief counseling. The objective of this study was to compare the effect sizes of two intensive interventions for prenatal smoking cessation: contingency management (i.e., financial incentives for abstinence) and psychotherapy.

Individual, Social-Normative, and Policy Predictors of Smoking Cessation: A Multilevel Longitudinal Analysis

Objectives. We assessed the prospective impact of individual, social-normative, and policy predictors of quit attempts and smoking cessation among Massachusetts adults.Methods. We interviewed a representative sample of current and recent smokers in Massachusetts by telephone in 2001 through 2002 and then again twice at 2-year intervals. The unit of analysis was the 2-year transition from wave 1 to wave 2 and from wave 2 to wave 3. Predictors of quit attempts and abstinence of longer than 3 months were analyzed using multilevel analysis. Predictors included individual, social-normative, and policy factors.Results. Multivariate analyses of 2-year transitions showed that perceptions of strong antismoking town norms were predictive of abstinence (odds ratio = 2.06; P < .01). Household smoking bans were the only policy associated with abstinence, but smoking bans at one''s worksite were significant predictors of quit attempts.Conclusions. Although previous research showed a strong relation between local policy and norms, we found no observable, prospective impact of local policy on smoking cessation over 2 years. Our findings provide clear support for the importance of strong antismoking social norms as a facilitator of smoking cessation.Increasing the rate of successful smoking cessation is one of the most effective public health strategies for improving the health of the population.¹ To provide guidance for future intervention efforts, it is vital that we understand the factors that contribute to successful cessation at the population level. Longitudinal studies of population-based samples are one of the best ways to examine the process of change in smoking behaviors.The UMass Tobacco Study was a 3-wave longitudinal investigation examining personal, social-normative, and policy factors that contribute to favorable change in smoking behavior among residents of a state that had a comprehensive tobacco control program in place for almost 10 years.² The study hypothesized that local clean indoor air policies and those that reduced youths'' access to tobacco would have a beneficial effect on adult smoking primarily by increasing antismoking norms. Local tobacco control regulations, such as restaurant smoking bans, may influence the way individuals perceive the community norm because they can no longer smoke in restaurants, because they observe fewer people smoking in restaurants, or because they see the restaurant''s “No Smoking” sign as indicating community disapproval. Regulations may influence individual''s perceptions even when their own behavior is not regulated. An adult who sees a store clerk check the identification of a young person attempting to buy cigarettes may infer that the community disapproves of tobacco use, at least by young people.Support for the hypothesis that strong local policies affect social norms about smoking was obtained in an analysis of the baseline data from the UMass Tobacco Study, which showed that adults living in towns with higher numbers of strong tobacco control policies were more likely than those living in towns with fewer policies to report that town residents disapproved of smoking and that fewer people smoked.³ This relationship remained significant even after preexisting antitobacco sentiment in the town and other demographic characteristics of the town and its residents were controlled. The connection between policy and norms was also shown in cross-sectional analyses of the impact of local restaurant smoking bans on youths'' perceptions of norms.⁴     

Motivations for tobacco consumption among adolescents in an urban high school

Objective

To determine the motivations (attitudes, beliefs and experiences) for tobacco consumption among adolescents.

Methods

This study was based on qualitative methodology using six 50-minute discussion groups with 6-8 adolescents per group during the 2008/09 school year. Purposive sampling was performed of 12-18 year-old adolescents attending a middle-class urban school (Jaén, Spain). The sample was stratified by educational level as the homogeneity criterion and gender and tobacco consumption as the heterogeneity criterion. Content analysis consisted of coding, triangulation of categories and obtaining and verifying the results.

Results

There were 44 adolescents (54% male). The participants reported that smoking relaxed and improved self-image, providing security (boys) and improving relations with the opposite sex, as well as weight control (girls). The family encouraged smoking by providing a model to imitate, although many adolescents hid their smoking from their families. Friends constituted a pressure group to start or continue smoking. Starting secondary school marked the beginning of experimental use. Society tended to accept consumption and buying tobacco was easy for minors. University students were a role model and were free to smoke. The adolescents looked to their parents and educators/health workers to provide a model of abstinence and reported that they were well informed but only remembered powerful messages. Participants unanimously indicated that tobacco causes addiction, but in proportion to the duration of consumption, and were concerned only with the immediate symptoms caused by smoking. Teenage smokers associated multiple drug use with leisure time.

Conclusions

This study provides useful data on motivation that could be used to improve smoking prevention interventions among adolescents. The most important factors seem to be peer influence, parental attitudes, easy access to tobacco and symptoms of dependence.     

Life-style and self-rated global health in Sweden: A prospective analysis spanning three decades

Objective

To study the relations between lifestyle factors (smoking, drinking, exercise, vegetable consumption, social relations) and global self-rated health in the adult Swedish population.

Method

The data come from the Swedish Level of Living Survey, a face-to-face panel study. The analysis follows the respondents with good health in 1991 (N = 4035) and uses multivariate logistic regression to assess the relations between lifestyle factors in 1991 and health in 2000 and 2010.

Results

Baseline (1991) exercise, social support, smoking and vegetable consumption are associated with health in 2000 and/or 2010. 2000: Weekly exercise in 1991 increases the probability of good health by 6 percentage points [95% CI: 1–10] compared to no exercise, and smoking 10 or more cigarettes a day decreases the probability of good health by 5 percentage points [95% CI 1–8]. Lacking social support decreases the probability of good health by 17 percentage points (95% CI: 9–25). 2010: Smoking 10 or more cigarettes a day decreases the probability of good health by 10 percentage points [95% CI 5–15], and eating vegetables every day increases the probability of good health by 4 percentage points [95% CI 0.2–7].

Conclusions

Exercise, smoking, social support and vegetable consumption are related to self-rated health 2000 and/or 2010.     

Associations of smoking and smoking cessation with CT-measured visceral obesity in 4656 Korean men

Objectives

Although obesity is shown to be less common among current smokers than never smokers, the association between visceral obesity and smoking remains uncertain.

Methods

For this cross-sectional analysis, we recruited 4656 Korean men of 19 to 79 years who received a regular checkup at a health examination center between 2008 and 2010. Computed tomography was performed to measure the area of visceral and subcutaneous adipose tissue (VAT and SAT). We compared the mean VAT by multiple regression analysis across smoking status after adjusting for confounders.

Results

Both current and former smokers had more mean VAT than never smokers. Current smokers who consumed more than 20 cigarettes per day had 11% higher mean VAT than never smokers (P < 0.01). Longer smoking duration, higher daily cigarette consumption before quitting, and shorter abstinence duration among ex-smokers were associated with increasing mean VAT (all P for trend < 0.01). The mean VAT in former smokers was highest within 2 years of abstinence. There was no significant difference of mean VAT between ex-smokers with > 20 years of abstinence duration and never smokers.

Conclusion

Both current and former smoking is associated with increased VAT. The risk of visceral obesity is proportional to the degree of exposure to cigarette smoking.     

Smoking cessation and body weight: evidence from the Behavioral Risk Factor Surveillance Survey

Objective

To investigate the role of smoking cessation in body weight.

Data Sources

2004–2005 and 2009–2010 Behavioral Risk Factor Surveillance Surveys (BRFSS) (N = 349,000), Centers for Disease Control and Prevention; Tax Burden on Tobacco (Orzechowski and Walker 2010).

Study Design

The Gaussian treatment effect model is estimated for three age categories by gender. Treatment effects of quitting smoking on body mass index (BMI) by quit length are calculated.

Principal Findings

Quitting is found to be endogenous. Differentiated effects of quitting smoking on BMI are found among quitters by gender, between age groups, and by length of time since quitting smoking, and positive association between smoking cessation and body weight confirmed. Declining smoking rates have only a modest effect in the overweight population. The effects of quitting on BMI are considerably lower among younger men and women.

Conclusion

The price that must be paid, in terms of weight gain, to enjoy the health benefits of smoking cessation is trivial even for the obese population.