The individual and combined effects of cigarette smoking and food on resting energy expenditure.

The influence of cigarette smoking and food intake on resting energy expenditure (REE) was investigated. Fifteen smokers were presented, over four days, with cigarette consumption, food consumption, the consumption of both cigarettes and food, and neither cigarettes nor food consumption. Results indicated that both food and cigarette smoking increased REE and food increased REE considerably more than smoking cigarettes (17.1 vs 7.5 percent). The combination of the two was less than additive (24.1 percent). The results may aid in elucidating the mechanisms that contribute to a lowered body weight in smokers.     

Cigarette smoking and lung disease

Despite major changes in the patterns of cigarette consumption in the United States in the last two decades, cigarette smoking remains a widespread practice. Many studies show a strong association between cigarette smoking and chronic obstructive lung disease, but only recently have mechanisms been elucidated to explain this association, particularly in the case of emphysema. The exact mechanism of chronic bronchitis is less well defined. The mortality rate for lung cancer continues to increase in this country, particularly among women. Compelling evidence associates lung cancer with cigarette smoking, although animal models have not been very successful. Recently, concern has been raised about the effects of passive smoking. There are substantial data available to suggest that passive smoking results in pulmonary infections and abnormal pulmonary function in children of smokers. The data are less clear-cut for pulmonary functional impairment in adults and for lung cancer in the spouses of smokers. Although the concept of "safer" cigarettes has been widely accepted by the American public, these cigarettes may not be as safe as is widely assumed. Clearly, they are far inferior to total smoking cessation. Nevertheless, smoking cessation remains difficult for many Americans, despite a number of methods that have been used to help smokers quit. Nicotine chewing gum, which has recently become available for use in the United States, has shown some efficacy in helping well-motivated, nicotine-dependent smokers quit smoking. Although some inroads have been made into the occurrence of smoking related diseases in the United States, many unnecessary deaths continue to occur.     

Alcohol consumption and chronic obstructive pulmonary disease

This study examined the relationship between lifetime alcohol consumption and respiratory symptoms in 195 subjects (including 111 alcoholics) and FEV1 level in 165 subjects (including 91 alcoholics). After adjustment for age and cigarette smoking status, using multiple logistic regression, lifetime alcohol consumption was a significant predictor of chronic cough and chronic phlegm, but not of any wheeze or persistent wheeze. Multiple linear regression analysis indicated that lifetime alcohol consumption was also a predictor of lower levels of FEV1 in a model that included age, pack-years of cigarette smoking, and an interaction between alcohol consumption and pack-years. The interaction between smoking and alcohol consumption was in a direction opposite to the independent effects of alcohol and smoking, suggesting a protective effect of alcohol with heavier amounts of smoking. Additional study is needed to further assess the relationship between respiratory symptoms and alcohol consumption, and between pulmonary function and alcohol consumption.     

The role of peer affiliations, social, family and individual factors in continuities in cigarette smoking between childhood and adolescence

The continuity between early smoking experimentation and smoking at age 16 years was analysed for a birth cohort of New Zealand children. This analysis suggested that when due allowance was made for errors in reports of smoking behaviours, there was evidence of relatively strong continuity (r= 0.60) between early smoking experimentation and cigarette smoking at age 16 years. Further analysis suggested that the continuities between early smoking experimentation and later smoking arose from three pathways that linked early smoking experimentation to later smoking. First there was evidence to suggest that children who engaged in early smoking experimentation tended to affiliate with adolescent peer groups whose members smoked. In turn, these peer group affiliations reinforced pre-existing tendencies to cigarette smoking. Secondly, a small component of the apparent continuity between early smoking experimentation and later smoking arose because of common social, individual and contextual factors that were associated with both smoking experimentation and later smoking. Finally, there was evidence of moderate direct continuity in cigarette smoking behaviour over time. The implications of these findings for the development of smoking prevention programmes are discussed and it is concluded that effective programmes need to be embedded in a developmental approach which attempts to reduce both early smoking experimentation and the effects of peer pressure in adolescence on the development of cigarette smoking.     

Passive smoking in childhood—Tobacco smoke

Prevalence of cigarette smoking varies widely in different countries, ranging, at the age of 13, from 2% to 5% (Sweden, United States) to more than 30% (Australia, Uruguay). Even if the prevalence of smokers among male adolescents is decreasing in western countries, it is increasing among girls and, in developing countries, male adolescent smokers still reach 40% (and up to 70%–80%). The determination of saliva cotinine levels, a product of nicotine metabolism, is an useful indicator of exposure to passive or active smoking. In a study of 210 children aged 9–13 years, we found detectable levels of saliva cotinine in 13% of children who lived in nonsmoking families and denied being regular smokers and in only 60% of children living in families with heavy cigarette consumption. This wide variations of a marker of smoking exposure may explain the differences in reported consequences of tobacco smoke in investigations conducted in different places and on different target populations. We later studied the effects of environmental tobacco smoke (ETS) in a sample of 166 nine-year-old children. The relationship between parental smoking and degree of bronchial responsiveness in males was significant. Also, prick skin test reactivity to allergens was significantly increased in children of smoking parents. Many studies concerning the effects of ETS exposure seem to demonstrate that not only the lungs and not only children are affected even if the difficulty of the epidemiology in such a field must suggest caution in interpreting the results. However, on the basis of the present evidence, ETS exposure has to be considered a general toxic source for humans and its harmful effects appear even more unacceptable because, at least theoretically, they could be easily prevented.     

Relationship between weight change and the reduction or cessation of cigarette smoking

To determine the relationship between body weight and reduction or cessation of cigarette smoking, body weight and height as well as serum thiocyanate concentration were measured in 107 persons before and after participation in smoking-cessation programs. Body weight increased in only 67.3 percent of cases, but increases in body weight were associated with the greater reduction in cigarette consumption while the absence of weight gain was associated with a small reduction in cigarette consumption. Body weight increases after participation in the program were significantly (P less than 0.05) greater in men than in women despite the absence of a significant difference in the reduction of cigarette consumption between men and women. Analysis of variance failed to show a significant deviation from linearity in the significant relationship between reduction in tobacco consumption and increase in body weight. A number of variables assessed at entry into the study, such as age, age at starting smoking, cigarette consumption, initial body weight or anxiety level (Manifest Anxiety Scale) did not correlate with the change in weight in men or women. These data suggest that the most important determinant of weight gain is the amount of reduction in cigarette consumption and that there are important sex differences in response of body weight to reduction of tobacco consumption.     

Lifestyle and the risk of rheumatoid arthritis: cigarette smoking and alcohol consumption.

In a search for aspects of behaviour related to oral contraceptive use which might explain the favourable effect of oral contraception on the onset of rheumatoid arthritis (RA), cigarette smoking and alcohol consumption were studied as possible risk factors. Information on cigarette smoking and alcohol consumption was obtained by interview at the first visit to the outpatient clinic of 135 young women with confirmed definite or classical RA of recent onset and 378 control patients with soft tissue rheumatism or osteoarthritis. The diagnosis in all patients was confirmed by at least two years of follow up. Of the patients with RA, 44/135 (33%) were current cigarette smokers compared with 181/378 (48%) of the controls. The percentage of smokers among the controls was similar to that of women smokers in the general population. The adjusted risk of RA in women who smoked at least one cigarette a day was 0.61 (95% confidence interval (CI) 0.42 to 0.89). Thirty one (23%) patients with RA and 137 (36%) controls were alcohol drinkers. The risk of RA in women who consumed alcohol at least once a day was 0.52 (95% CI 0.33 to 0.84). The low relative risk estimates for cigarette smoking and alcohol consumption were mutually independent and also independent of oral contraceptive use, the presence of the HLA-DR4 antigen, or a positive family history of RA. The low incidence of alcohol consumption in the patients with RA might be due to the discontinuation of alcohol consumption after disease onset. The low incidence of cigarette smoking in the patients might reflect a protective effect of cigarette smoking on RA onset, possibly induced by changes in the immune system.     

Passive smoking, gas cooking, and respiratory health of children living in six cities

As part of a longitudinal study of the respiratory health effects of indoor and outdoor air pollutants, pulmonary function, respiratory illness history, and symptom history were recorded at 2 successive annual examinations of 10,106 white children living in 6 cities in the United States. Parental education, illness history, and smoking habits also were recorded, along with the fuel used for cooking in the child's home. Maternal cigarette smoking was associated with increases of 20 to 35% in the rates of 8 respiratory illnesses and symptoms investigated, and paternal smoking was associated with smaller but still substantial increases. Illness and symptom rates were linearly related to the number of cigarettes smoked by the child's mother. Illness rates were higher for children of current smokers than for children of ex-smokers. The associations between maternal smoking status and childhood respiratory illnesses and symptoms were reduced but not eliminated by adjustment for parental illness history. Levels of forced expiratory volume in one second (FEV1) were significantly lower for children of current smokers than for children of nonsmokers at both examinations and highest for children of ex-smokers. Levels of forced vital capacity (FVC) were lower for children of nonsmokers than for children of current smokers at both examinations, but the difference was statistically significant only at the first examination. Both the increase in mean FVC and the decrease in mean FEV1 among children of current smokers were linearly related to daily cigarette consumption. None of the respiratory illnesses and symptoms studied was significantly associated with exposure to gas cooking in the child's home.(ABSTRACT TRUNCATED AT 250 WORDS)     

Acute effects of smoking and food consumption on breath condensate pH in healthy adults

Acute effects of food and cigarette consumption on exhaled breath condensate (EBC) acidity are insufficiently explored. The study aimed to evaluate potential changes in EBC pH within 2 hours following cigarette or food consumption. In 15 healthy smokers, samples were obtained after 10 hours of abstinence from smoking and then 15, 30, 60, and 120 minutes after smoking 1 cigarette. In 19 healthy nonsmoking adults, EBC samples were obtained in the morning after an overnight fast, and then 30, 60, and 120 minutes following standardized breakfast. Smoking of 1 cigarette after overnight tobacco abstinence induced significant increase in EBC pH during the 2-hour observation period, for approximately 0.60 logarithmic units (repeated-measures analysis of variance [ANOVA], P < .0001). The average presmoking pH value in smokers (7.00 ± 0.50) was significantly lower than average value in nonsmokers (7.62 ± 0.31; P = .0001). No effect of food consumption was found. These results show that cigarette smoking acutely increases EBC pH in healthy smokers. Smoking status and abstinence from smoking before EBC sampling seems to be important in studies evaluating EBC pH and should be standardized or at least stated in the methodology. Acute effects of food were not found under described study conditions in healthy adults.     

Blood pressure, coffee, tea and tobacco consumption: an epidemiological study in Algiers

The connections and possible interactions between coffee consumption,tobacco consumption, blood pressure (BP), age, and body massindex (BMI) were analysed in a cross-sectional epidemiologicstudy of 1098 men and 393 women of the Algiers district. Systolicblood pressure (SBP) was negatively and significatively correlatedwith cigarette smoking. Diastolic blood pressure (DBP) was positivelyand significantly associated with coffee consumption (P<0.001)and negatively and significantly with cigarette consumption(P<0.001). These associations remained significant aftermultivariate analysis including sex, age, BMI, physical exertionat work, athletic activity, rural versus urban residency, tobacco,tea and coffee consumption. Coffee consumption and cigarettesmoking were positively associated (P<0.001). In the subgroupof men, the association between coffee consumption and DBP wassignificant only after adjustment for cigarette smoking. Inthe subgroup of women, containing a low percentage of smokers,this association was significant without such adjustment. Thisfinding suggests that cigarette consumption might partly maskthe association between coffee consumption and BP. The contradictoryinteractions observed between BP, cigarette consumption andcoffee consumption might help to explain the conflicting reportsconcerning the association between coffee consumption and ischemicheart disease.     

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.     

Relationship of cigarette smoking to blood pressure and serum lipids

The relationship between cigarette smoking and blood pressure and serum lipids was studied in 1775 men aged 20-59 years, in non-drinkers and drinkers separately, controlling for body mass index and physical fitness (VO2max). While systolic blood pressure was not associated with cigarette smoking, diastolic blood pressure decreased with increasing levels of cigarette smoking in non-drinkers but not in drinkers. Total cholesterol was inversely associated with smoking cigarettes in drinkers and was not associated in non-drinkers. High density lipoprotein (HDL)-cholesterol decreased with an increasing degree of cigarette consumption in non-drinkers but not in drinkers. An increase in total cholesterol/HDL-cholesterol ratio and triglyceride levels was positively associated with smoking cigarettes regardless of drinking habit. The present study suggests that cigarette smoking is a cardiovascular risk factor, partly due to its effect of increasing the atherogenic index, but it remains to be consolidated whether chronic smoking has an effect of lowering diastolic blood pressure.     

SMOKING WITHDRAWAL PROGRAMME: BASELINE INDICATORS OF SMOKING EXPOSURE AND BIOCHEMICAL MONITORING OF SUCCESSFUL OUTCOME

Sixty-four subjects Who participated in a smoking withdrawal programme were analysed with respect to the relative usefulness of biochemical and hematological indices of smoking exposure. Plasma thiocyanate was found to be the best biochemical correlate of baseline cigarette consumption when compared to salivary thiocyanate or expired air carbon monoxide. Both plasma and salivary thiocyanate also correlated significantly with depth of inhalation per cigarette but not with any other questionnaire index of smoking exposure. After six weeks of successful smoking cessation all three indices fell significantly. Plasma thiocyanate proved the most sensitive biochemical index for monitoring ultimate outcome, accurately dichotomizing 90% of subjects as successful or unsuccessful in their attempts to stop smoking. The use of all three variables allowed accurate classification of 96% of subjects. White cell count, red cell count and hemoglobin also correlated significantly with baseline cigarette consumption and a significant decrease in these hematological indices occurred consequent to successful smoking cessation. However, these hematological changes were not as sensitive as biochemical indices in monitoring successful outcome.     

Smoking prevalence, nicotine dependence and effects of low cost cigarette sale among military healthcare personal in Turkish Republic of Northern Cyprus

Health professionals, particularly clinicians and nurses in the community have an important role in preventing to start smoking. In our study; we aimed to determine the prevalence of cigarette smoking, nicotine dependence level and the effects of low price tobacco sale among healthcare personal in a military hospital. A questionnaire was applied to healthcare personal, which evaluates their smoking habits, nicotine dependence level with Fagerstr?m Test for Nicotine Dependence (FTND) and the effects of low cost cigarette sale on smoking habits. Seventy male and 46 female among 138 healthcare personals (84%) responded to the questionnaire. Mean age of participants was 33.7 ± 5.6. Among all participants, 53.4% were smoking. There was no significant difference between male and female participants in case of smoking prevalence (p> 0.05). Seven participants who started smoking regularly after they appointed to Turkish Republic of Northern Cyprus explained why they started smoking as secondary to lower cigarette prices in this country. 48.3% of participants (40% of male smokers and 59.3% of female smokers) reported increased cigarette consumption as a result of low cost cigarette sales. There was a significant difference between male and female participants in case of increase in cigarette consumption (< 0.05). According to results of FTND, about 70% of participants were low and very low-dependant, and about 22% were high and very high- dependant smokers. Smoking prevalence of healthcare personal who participated in our study was higher than that reported for community and for other healthcare personal.     

Cigarette smoke – an aging accelerator?

Cigarette smoking reduces life span by an average of 7 years, and tobacco consumption accounts for a shortening of disease free life by 14 years. The exact mechanisms by which smoking causes disease and death are generally not well understood, but evidence continues to mount that cigarette smoking exhausts cellular defense and repair functions, leading to an accumulation of damage e.g. mutations and malfunctioning proteins. In this review, we make an attempt to ascribe many of the deleterious effects of smoking on human health to a general principle, namely the acceleration of aging processes by cigarette smoke chemicals.     

Cigarette consumption and socio-economic circumstances in adolescence as predictors of adult smoking

Aim To investigate effects of cigarette consumption level and socio‐economic circumstances during adolescence on adult smoking. Methods 1958 British birth cohort (all births 3–9 March 1958). Logistic regression used to predict (i) smoking at 41 years and (ii) persistent smoking (at 23, 33 and 41 years) from cigarette consumption and socio‐economic circumstances at 16 years, indicated by social class and educational qualifications. Results Of 6537 subjects with full smoking history, 30% smoked at 16 years, 23% smoked at 41 years and 19% smoked at 23, 33 and 41 years (persistent smokers). Heavier smokers at 16, 23 and 33 years were more likely to smoke at 41 years than lighter smokers. The odds ratio (OR) of smoking at 41 years was 2.5 for men and 3.0 for women who smoked ≥60 cigarettes/week at age 16, relative to <20 cigarettes/week. Subjects from manual social backgrounds and those with no qualifications had elevated risks of being a smoker at 41 years or a persistent smoker. These effects were robust to adjustment for adolescent consumption level (e.g. adjusted OR for no qualifications was 3.8). However, adolescent consumption level modified the effect of educational achievements. Among lighter adolescent smokers, those gaining higher qualifications had lower prevalence of smoking at 41 years (16%) than men with no qualifications (83%); among heavier adolescent smokers, prevalence was more similar for subjects with higher (56%) and no qualifications (69%). Conclusions Socio‐economic background appears to influence adult smoking behaviour separately from adolescent cigarette consumption which is a recognized measure of nicotine dependence. There was some evidence that effects of early nicotine dependence are modified by educational achievements.     

Cigarette smoking, alcohol consumption, and risk of ARDS: a 15-year cohort study in a managed care setting

STUDY OBJECTIVE: To examine the association of cigarette smoking and alcohol consumption with hospital presentation of ARDS in a well-defined, multiethnic population. DESIGN: Retrospective cohort study. SETTING: Health maintenance organization in Northern California. PARTICIPANTS: A total of 121,012 health plan subscribers (54.2% women), aged 25 to 89 years. OUTCOME MEASURE: Hospital presentation of ARDS (validated by medical chart review) from baseline in 1979 to 1985 through the end of 1993 (median, 9.9 years). RESULTS: There were 56 cases of ARDS (33 in men, 23 in women). The case fatality rate was 39% in both genders. ARDS was independently related to increasing age (rate ratio of 10 years, 1.38; 95% confidence interval [CI], 1.12 to 1.71), to current smoking of < 20 cigarettes/d (rate ratio vs never cigarette smokers, 2.85; 95% CI, 1. 23 to 6.60), and to current cigarette smoking of > or = 20 cigarettes/d (rate ratio vs never smokers, 4.59; 95% CI, 2.13 to 9.88). No association was observed between alcohol consumption and ARDS. CONCLUSIONS: The results of this study suggest a relationship (with evidence of dose-response effect) between cigarette smoking and ARDS. Assuming a causal relationship, approximately 50% of ARDS cases were attributable to cigarette smoking.     

Children's purchases of single cigarettes: eviDence for drug pushing?

The purchase of single cigarettes from shops by children aged 14 and 15, to whom all cigarette sales are illegal, was studied in a survey of 3513 teenagers attending nine state secondary schools in the Bristol area. Of those children who had tried smoking only once, 5% reported having at some time purchased a single cigarette from a shop. This percentage rose to 18% in current occasional smokers of less than 1 cigarette per week, and reached 52% in those smoking more than 6 cigarettes per week. There was no difference by sex or age, but some eviDence of an association with family smoking habits and with social class, and wide variation between schools. In the school with the highest incidence, 80% of regular daily smokers had at some time bought single cigarettes from a shop, compared with 14% in the school with the lowest. Only 1% of children who smoked said that buying single cigarettes from shops was their usual way of getting cigarettes. Our results imply a cynical flouting of the law by many shopkeepers who are acting straightforwardly as drug pushers.     

Cotinine validation of self-reported smoking in commercially run community surveys

A validation study was carried out on self-reported smoking for 1177 people in Sydney and Melbourne in 1983. Because of its long half life and the fact that smoking is its only source in body fluids, saliva cotinine was chosen as the validation measure. Cotinine levels above 250 nmol/l were used to classify people as smokers. The sensitivity of self-reported smoking was 92.6% and the specificity was 93.4%. There was some evidence that people in the process of changing their smoking status might be slow in updating their self-classification. The smoking prevalence estimate based on cotinine levels was found to be 1.7% lower than that for self-reported smoking status. The small proportion of false negatives and false positives suggests that commercially collected data banks can be valid sources of prevalence data. Correlation between cotinine level and reported cigarette consumption was not affected by sample volume, and was similar to that achieved for carbon monoxide and thiocyanate at a low 0.34. Regression analysis using self-reported cigarette consumption filter/non-filter cigarettes, and time since last cigarette as predictors, explained 13.6% of the variance in cotinine level.     

Smoking Prevalence Among General Practitioners' Patients

The prevalence of smoking is reported in a representative sample of 2,616 patients attending the surgeries of 28 General Practitioners (GPs) in London. 43% of the men and 34 % of the women were current cigarette smokers. These figures are substantially lower than those of the general population due to a higher proportion of ex-smokers rather than those who have never smoked. Daily cigarette consumption of current smokers, at 19 per day for men and 16 per day for women, was similar to the general population. The excess of ex-smokers was comprised mainly of those who had stopped smoking recently possible due to the current illness causing their attendance at the surgery, and who under natural circumstances would be likely to start smoking again after recovery. Besides current cigarette smokers, this group of recent ex-smokers would seem an ideal target for preventive intervention by GPs.