The relationship between smoking status and cortisol secretion

CONTEXT: Evidence for an association of smoking status with cortisol secretion is mixed. OBJECTIVE: The objective of the study was to assess the relationship between smoking status and salivary cortisol. DESIGN: This was a cross-sectional study of smoking status and cortisol secretion from phase 7 (2002-2004) of the Whitehall II study. SETTING: An occupational cohort was originally recruited in 1985-1987. PARTICIPANTS: The study population consisted of 3103 men (1514 never-smokers, 1278 ex-smokers, and 311 smokers) and 1128 women (674 never-smokers, 347 ex-smokers, and 107 smokers). Information was collected on smoking status, average number of cigarettes smoked, and additional covariates. OUTCOME MEASURES: Saliva samples were taken on waking; waking + 0.5, 2.5, 8, and 12 h; and bedtime for the assessment of cortisol. RESULTS: Smoking status was significantly associated with increased salivary cortisol release throughout the day (P < 0.001) adjusted for covariates; this was apparent for the cortisol awakening response (P < 0.001) when examined separately. Compared with never-smokers, smokers had higher release of total cortisol (P = 0.002), whereas no difference was observed between never-smokers and ex-smokers (P = 0.594): mean release per hour (nanomoles per liter), never-smokers, 4.13 [confidence interval (CI) 4.02-4.24]; ex-smokers, 4.21 (CI 4.08-4.35); smokers, 4.63 (CI 4.35-4.93). There was no significant relationship between number of cigarettes smoked and total cortisol release. However, a difference was observed for the cortisol awakening response: mean release by tertiles of cigarettes smoked (nanomoles per liter): high, 13.49 (CI 10.74-16.23); medium, 9.58 (CI 7.40-11.76); low, 8.49 (CI 5.99-10.99), P = 0.029. CONCLUSION: Salivary cortisol is increased in current smokers, compared with nonsmokers; no differences were observed between ex-smokers and never-smokers, suggesting that smoking has a short-term effect on the neuroendocrine system.     

The relationship between alcohol consumption patterns and injury

Aims and design. A case-control design was employed to quantify the risk of injury after the recent consumption of alcohol. Participants and setting. A total of 797 cases and 797 controls were interviewed throughout 1997. A response rate of 82% was calculated for eligible cases who were approached by an interviewer. The rate for interviews conducted of all people presenting with an injury during the study period was 67%. Cases were injured patients from a hospital emergency unit. Controls were matched on suburb and were interviewed at home regarding activities leading up to the time of their matched case's injury. Measurement. Cases and controls were questioned about the injury event and alcohol and other drug use consumed in the 6 hours prior to the injury. They were also breath-tested and medical records were checked for validation purposes. Findings. Logistic regression analysis produced an odds ratio of 3.4 (95% CI: 1.8-6.4) for the risk of sustaining an injury after consuming more than 60 g of alcohol in a 6-hour period, after controlling for demographic variables. The risk of injury at different levels of alcohol use was substantially higher for females with a significant odds ration of 9.6 at greater than 60 g of alcohol compared to 2.1 for men. Conclusions. These results need to be interpreted cautiously, but provide additional support that the risk of injury increases with the quantity of alcohol consumed and that the risk of injury is significantly higher for women.     

The relationship between stressful working conditions and high alcohol consumption and severe alcohol problems in an urban general population

The relationship between 15 measures of stressful working conditions and high alcohol consumption (35 g 100% ethanol per day or more for men and 25 g or more for women) was studied, using cross-sectional data from a general population survey of 1344 males and 1494 females; the ages 25–64 years in metropolitan Stockholm in 1984. In a longitudinal component of the study, hospitalization and mortality with alcohol-related diagnosis was assessed during 1984–90, and also the association between previous experience of unemployment and high alcohol consumption. Some of the associations, expressed as age-adjusted odds ratios, were positive and some were negative when high alcohol consumption was the endpoint, but there was a clear variation by sex and social class. Generally the positive associations were stronger among male non-manual employees. Among males, there was a clear association between stressful working conditions and subsequent risk of severe medical alcohol-related problems, but the precision of the estimates was low due to low number of cases. The odds ratio was 6.18 (95% confidence interval 1.86, 20.61) for twisted working positions and 6.74 (95% confidence interval 1.67, 27.19). Previous unemployment among males was associated with increased risk for high alcohol consumption, with an odds ratio of 5.71 (95% CI 1.39, 15.97) among those who had been unemployed more than once, and 1.67 (95% CI 0.76, 3.64) among those who had been unemployed once during the previous 5 years. Those and other increased odds ratios were lower when subjects with an alcohol diagnosis at inpatient care during 1980–84 were excluded in the analyses. On the whole, our findings are not conclusive. The strong, but imprecise associations between stressful working conditions and severe alcohol problems, are however challenging, and warrants further studies, preferably with longitudinal design and repeated measurements of both working condition and alcohol habits.     

The temporal relationship between college women's alcohol consumption and victimization experiences

BACKGROUND: The primary objective of the study was to assess changes in the conditional probability of sexual and nonsexual victimization on days of any alcohol consumption compared with days of heavy and no alcohol consumption in a sample of college women. METHODS: We used the Timeline Followback calendar method to assess daily alcohol consumption and concurrent daily incidents of sexual and nonsexual aggression over a 6-week period. RESULTS: The odds of experiencing sexual aggression were 9 times higher on heavy days and 3 times higher on nonheavy days of alcohol consumption compared with days of no alcohol consumption. The odds of experiencing nonsexual aggression were more than 7 times higher on heavy days and nearly 3 times higher on nonheavy days of alcohol consumption compared with days of no alcohol consumption. CONCLUSIONS: These findings provide evidence of a temporal association between college women's alcohol consumption and increased risk for victimization. In addition, use of the TLFB appears to be a reasonable and cost effective means for collecting daily data on alcohol consumption and victimization experiences among college women.     

Momentary relationship between cortisol secretion and symptoms in patients with fibromyalgia

OBJECTIVE: To compare the momentary association between salivary cortisol levels and pain, fatigue, and stress symptoms in patients with fibromyalgia (FM), and to compare diurnal cycles of cortisol secretion in patients with FM and healthy control subjects in a naturalistic environment. METHODS: Twenty-eight patients with FM and 27 healthy control subjects completed assessments on salivary cortisol levels and pain, fatigue, and stress symptoms, 5 times a day for 2 consecutive days, while engaging in usual daily activities. Only those participants who adhered to the protocol (assessed via activity monitor) were included in the final analyses. RESULTS: Twenty FM patients and 16 healthy control subjects adhered to the protocol. There were no significant differences in cortisol levels or diurnal cortisol variation between FM patients and healthy controls. Among women with FM, a strong relationship between cortisol level and current pain symptoms was observed at the waking time point (t = 3.35, P = 0.008) and 1 hour after waking (t = 2.97, P = 0.011), but not at the later 3 time points. This association was not due to differences in age, number of symptoms of depression, or self-reported history of physical or sexual abuse. Cortisol levels alone explained 38% and 14% of the variation in pain at the waking and 1 hour time points, respectively. No relationship was observed between cortisol level and fatigue or stress symptoms at any of the 5 time points. CONCLUSION: Among women with FM, pain symptoms early in the day are associated with variations in function of the hypothalamic-pituitary-adrenal axis.     

The relationship between hostility, smoking, and alcohol consumption in Mexican Americans

We examined the effect of hostility on smoking and alcohol consumption using data from a three-generation study of Mexican Americans. The irritability subscale of the Buss-Durkee Hostility Inventory was used as the measure of hostility. Moderate associations were found between alcohol consumption and irritability scores among middle- and younger-generation females, with generally weaker or nonsignificant associations found in males. Smoking was moderately associated with irritability in middle- and younger-generation females and in younger-generation males. Differences in results by generation and gender are discussed as well as implications for future research.     

Vague relationship between alcohol consumption and metabolic syndrome in nonobese people

Fatty liver, including non-alcoholic fatty liver disease, is closely associated with metabolic syndrome (MS). Thus, the presence of fatty liver without MS in some conditions may be clinically important. Many studies have shown that compared with no or occasional alcohol intake, moderate alcohol consumption is associated with lower prevalence rates of hypertension and type 2 diabetes, and lower levels of circulating C-reactive protein, a valuable marker for MS and insulin resistance. Considering these findings, light to moderate alcohol consumption has theoretical benefits on fatty liver and MS. Fatty liver, including non-alcoholic fatty liver disease, may be more clinically important than MS, particularly in non-obese individuals, because fatty liver can develop before MS in several conditions, such as regular alcohol consumers. Furthermore, most of the currently used MS criteria are unable to detect “true MS” because of variations in multiple factors such as age, height, medications, and complications.     

The relationship of sex-related alcohol expectancies to alcohol consumption and sexual behavior

Recent psychosocial research on alcohol expectancies beliefs about the effects of alcohol on behavior, moods and emotions has suggested that these expectancies mediate not only decisions about drinking but the alcohol effects displayed by those who have been drinking. Results of a study of drinking and sexual behavior showed that individuals of different gender and sexual orientation differed in their beliefs about the effects of alcohol on sexual responding. In addition, expectations of sexual enhancement and disinhibition were related to the initiation of sexual activity and to the proportion of sexual encounters that took place while drinking, and interacted with sex guilt to predict the amount drunk in the most recent sexual encounter. These results suggest that beliefs about the effects of alcohol on sex may affect the characteristics of sexual encounters that involve drinking.     

The relationship between stressful life situations and changes in alcohol consumption in a general population sample

Studies on the relationship between stressful life situations and alcohol consumption have almost exclusively been based on retrospective information from clinical populations. We conducted multiple regression analyses of the relationship between presumed stressful life conditions in 1965, life events during 1966–73 and psychosocial factors and amount of increase or decrease in alcohol consumption from 1965 to 1974 adjusting for age, alcohol consumption, education and health status in 1965. Data from surveys in 1965 and in 1974 in a general population sample of 4,864 subjects from Alameda County, California were used. The magnitude of the associations between the presumed stressful life situations and amount of change was generally low, although a few were statistically significant. However, among those aged 65 years and above, and especially among men, some of the associations were strong, but imprecise due to the low number of subjects in those ages. While a number of variables were associated with increase or decrease in alcohol consumption, the R²-values indicated that these variables explained little of the variation over time in alcohol consumption. Thus, people in general seem to cope with stressful life situations by means, other than a longstanding increase in alcohol consumption.     

The effect of total body water on the relationship between alcohol consumption and carbohydrate-deficient transferrin

BACKGROUND: Clinicians agree that alcoholism commonly is overlooked in their patients, and that treating the symptoms without directing therapy to the underlying cause at best delays an inevitable decline in the patient's general health and well-being. The current analysis focused on carbohydrate-deficient transferrin (CDT), a promising biological marker of dangerous alcohol consumption. METHODS: Included in our study were men (730) and women (613) from study sites in Canada, Brazil, and Japan. All subjects were participants in the WHO/ISBRA Study on State and Trait Markers of Alcoholism, who completed an extensive demographic, medical, and behavioral survey and provided blood samples for determination of CDT levels. ANOVA and chi2 test for equality were used to examine the effect of total body water (TBW) on the alcohol consumption/CDT relationship. To examine whether accounting for differences in TBW improved the diagnostic properties of CDT when used as a state marker for alcohol consumption, odds ratios were calculated for men and women separately. RESULTS: Our results show that accounting for individual differences in TBW significantly influenced the alcohol consumption/CDT dose-response relationship. The effect of TBW was different for men compared with women. When we used a consumption cutoff value of 40 g/day and the CDTect recommended cutoffs (20 for men; 27 for women), adjusting for differences in TBW significantly increased diagnostic performance of CDT in men but not women. CONCLUSIONS: The dependence of CDT measures on body water content needs to be taken into account to maximize the performance of CDT as an effective state marker of alcohol consumption in males.     

Sensitivity of circulatory response to alcohol influences the relationship between alcohol consumption and blood pressure in Orientals

There is a genetic difference in sensitivity to alcohol in Orientals, which is known to be mainly due to polymorphisms of alcohol-metabolizing enzymes such as aldehyde dehydrogenase. Habitual alcohol drinking is a risk factor for hypertension. However, it has not been determined whether individual sensitivity to alcohol influences the relationship between alcohol consumption and blood pressure. In this study, the relationship between amount of alcohol consumption and blood pressure was compared between groups of subjects with low and high sensitivities of circulatory response to alcohol. Sensitivity to alcohol in subjects (306 male workers) was evaluated by a self-administered questionnaire on symptoms (skin flushing and palpitation) that appear when drinking alcohol. Weight, height and blood pressure were measured. In subjects with high sensitivity to alcohol, systolic blood pressure was significantly higher in the subgroup of moderate-to-heavy drinkers (30 g/day or more) than in the subgroups of non-drinkers and light drinkers (less than 30 g/day). On the other hand, in subjects with low sensitivity to alcohol, systolic blood pressure in the subgroup of non-drinkers was not significantly different from that in the subgroups of light drinkers and moderate-to-heavy drinkers. The amount of daily alcohol consumption was significantly correlated with both systolic and diastolic blood pressures in subjects with high sensitivity to alcohol but not in subjects with low sensitivity to alcohol. Pressor effects of alcohol drinking on blood pressure were significant only in subjects with high sensitivity to alcohol, suggesting that there is a greater risk of development of hypertension from drinking large amounts of alcohol in people with high sensitivity to alcohol.     

The relationship between physical performance and cardiac function in an elderly Russian cohort

This study aims to determine the cardiac dysfunction prevalence, to investigate the relationship between the Short Physical Performance Battery (SPPB) test and structural and functional echocardiographic parameters and to determine whether SPPB scores and cardiac dysfunction are independent mortality predictors in an elderly Russian population. A random sample of 284 community-dwelling adults aged 65 and older were selected from a population-based register and divided into two age groups (65–74 and ≥75). The SPPB test, echocardiography and all-cause mortality were measured. The prevalence of cardiac dysfunction was 12% in the 65–74 group and 23% in the ≥75 group. The multivariate models could explain 15% and 23% of the SPPB score total variance for the 65–74 and ≥75 age groups, respectively. In the younger age group, the mean follow-up time was 2.6 ± 0.46 years, and the adjusted hazard ratio (HR) for risk of mortality from cardiac dysfunction was 4.9. In the older age group, the mean follow-up time was 2.4 ± 0.61 years, and both cardiac dysfunction and poor physical performance were found to be independent predictors of mortality (adjusted HR = 3.4 and adjusted HR = 4.2, respectively). The cardiac dysfunction prevalence in this elderly Russian population was found to be comparable to, or even lower than, reported prevalences for Western countries. Furthermore, the observed correlations between echocardiographic abnormalities and SPPB scores were limited. Cardiac dysfunction was shown to be a strong mortality predictor in both age groups, and poor physical performance was identified as an independent mortality predictor in the oldest subjects.     

Relation between average alcohol consumption and disease: an overview

OBJECTIVE: To conduct an overview of alcohol-related health consequences and to estimate relative risk for chronic consequences and attributable fractions for acute consequences. METHODS: Identification of alcohol-related consequences was performed by means of reviewing and evaluating large-scale epidemiological studies and reviews on alcohol and health, including epidemiological contributions to major social cost studies. Relative risks and alcohol-attributable fractions were drawn from the international literature and risk estimates were updated, whenever possible, by means of meta-analytical techniques. RESULTS: More than 60 health consequences were identified for which a causal link between alcohol consumption and outcome can be assumed. CONCLUSIONS: Future research on alcohol-related health consequences should focus on standardization of exposure measures and take into consideration both average volume of consumption and patterns of drinking.     

The relationship between ethnicity, gender and alcohol consumption: a strategy for testing competing models

Aim. This study tested mediator, moderator and main effects models to determine the pattern of relationships between ethnicity, gender, temperament, and alcohol use . Design. A large-scale survey was employed. Respondents were interviewed in their homes. Participants were 523 Puerto Rican and 490 Irish American adults residing in the New York metropolitan area . Measures. Quantity and frequency of alcohol consumption were assessed with standard measures, and recent drinking problems with the substance abuse module of the Composite International Diagnostic Instrument . Findings. Rather than supporting a complex, nested model, the findings supported a main effects model and indicated that each of the three predictors was related to one or more drinking measure. While gender strongly influenced each drinking behavior, ethnicity only influenced frequency, and temperament only influenced recent drinking problems . Conclusions. The results support previous studies indicating consistent male-female drinking differences while highlighting a statistical strategy for comparing competing models of ethnic drinking behavior.     

The association between alcohol consumption patterns and adherence to food consumption guidelines

Objective: To examine the association between alcohol consumption patterns and adherence to major food consumption guidelines in adults in Spain. Methods: Telephone survey of 12,037 persons, representative of the population age 18 to 64 years in the region of Madrid, conducted from 2000 to 2005. The threshold between average moderate and excessive drinking was 40 g alcohol/d in men and 24 g/d in women. Binge drinking was defined as intake of ≥80 g alcohol in men and ≥60 g in women during 1 drinking session in the last 30 days. Food consumption was measured with a 24‐hour recall. Statistical analyses were performed using logistic regression and adjusted for the main confounders. Results: In total, 4.3% of study participants were excessive drinkers and 10.3% binge drinkers; 6.5% preferred spirits and 24.2% drank with meals. In comparison with never drinking, average moderate drinking with binge drinking was associated with excessive meat consumption (>1 serving/d). Excessive alcohol consumption without binge drinking was associated with insufficient intake of milk products (<2 servings/d) and excessive consumption of meat, fish, and eggs (>2 servings/d). Excessive drinkers with binge drinking more often did not meet the guidelines on consumption of fruit and vegetables (<3 servings/d), milk products, and meat. Excessive drinkers, with and without binge drinking, were more likely to skip a meal, especially breakfast. Consumption mainly of spirits was associated with insufficient fruit and vegetable consumption, and with skipping a meal. Finally, drinking at mealtimes was associated with poor adherence to most of the food consumption guidelines. No dietary differences between men and women were found in relation to alcohol consumption. Conclusions: Average excessive alcohol consumption, binge drinking, preference for spirits, and drinking alcohol at mealtimes are associated with poor adherence to major food consumption guidelines.     

The relationship of saline-induced changes in vasopressin secretion to basal and corticotropin-releasing hormone-stimulated adrenocorticotropin and cortisol secretion in man

To investigate the effect of endogenous arginine vasopressin (AVP) on ACTH secretion, normal subjects were given infusions of either hypertonic saline (HS) or isotonic saline (NS) combined with human corticotropin-releasing hormone (CRH) or placebo. Basal plasma AVP was 2.3 +/- 0.3 (+/- SE) pg/ml, did not change with NS treatment, and rose to 5.4 +/- 0.6 pg/ml during HS infusion (P less than 0.01). Both basal and CRH-stimulated plasma ACTH and cortisol concentrations increased during HS infusion. Peak plasma ACTH and cortisol levels were 11.4 +/- 1.5 pg/ml and 8.6 +/- 0.8 micrograms/dl, respectively, during the HS (plus placebo) infusion. During the NS (plus placebo) infusion, plasma ACTH and cortisol gradually declined to 6.8 +/- 0.5 pg/ml and 2.6 +/- 0.4 micrograms/dl. The timing of the rise in ACTH during the HS infusion paralleled the rise in AVP. When an iv dose of 1 microgram/kg CRH was administered during the saline infusions, peak plasma ACTH and cortisol levels were 27.7 +/- 6.3 pg/ml and 17.5 +/- 1.0 micrograms/dl, respectively, during the HS infusion and 15.6 +/- 1.7 pg/ml and 13.4 +/- 1.2 micrograms/dl during the NS infusion. When the areas under the hormone response curves were compared, CRH stimulated ACTH and cortisol secretion to a greater extent than did HS (P less than 0.05). The hormonal stimulation due to combined CRH and hypertonic saline was greater than that attributable to either factor alone (P less than 0.025), but was not different than the sum of the effects of the individual factors. These results indicate that increases in endogenous AVP produced by HS are associated with increases in both basal and CRH-stimulated ACTH and cortisol release. The effect of HS appears to be additive to but not consistently synergistic with the effect of CRH.