The effect of 3‐year parental smoking on asthma status of their children

ObjectiveWhilst the prevalence and severity of asthma influenced by environmental factors, the effect of parental smoking on asthma status of their children was examined.Patients and MethodsNinety asthmatic children, 32 with smoker and 58 with non‐smoker parents (baseline age, 8.5 ± 3.5 and 8.2 ± 3.3 respectively) were studies in two sessions 3 years apart by evaluating respiratory symptoms (RS) prevalence and severity, various drugs used, and pulmonary function tests (PFT) including forced vital capacity; forced volume in the first second, peak expiratory flow; and maximum expiratory low at 75, 50 and 25% of vital capacity (FVC, FEV1, PEF, MEF75, MEF50 and MEF25, respectively).ResultsThe prevalence and severity of all RS were significantly increased in asthmatic children with smoking parents after 3 years except prevalence and severity of night wheeze and the prevalence of chest wheeze (p < 0.05 to p < 0.001), but the PFT values were non‐significantly reduced. In asthmatic children with non‐smoking parents, the prevalence and severity of RS were decreased after 3 years, which was significant for night and chest wheeze for prevalence and night cough and chest wheeze for severity (all, p < 0.05), and the PFT values were increased, which were statistically significant for FVC, FEV1, MEF50 and MEF25 (p < 0.05 to p < 0.01). Drugs used by the group with smoking parents were increased and were significantly higher than their reduction in the groups with non‐smoking parents at the end of the study (p < 0.05 for fluticasone propionate 125/salmeterol and budesonide160/formoterol).ConclusionLong‐term parental smoking increased prevalence and severity of RS and drug used but decreased PFT values of their asthmatic children.     

Optimal lifestyle behaviors and 10‐year progression of arterial stiffness: The Multi‐Ethnic Study of Atherosclerosis

Majority of previous studies showed no association between a single health behavior and arterial stiffness, but the benefit of simultaneously having multiple healthy behaviors (optimal lifestyle) on the progression of arterial stiffness is unknown. Among 2810 individuals (age 60.0 ± 9.4, 46.5% male), optimal lifestyle marker (yes/no) on four health behaviors (ie, BMI < 25 kg/m², never or former smoker, never or moderate drinker, exercised > 500 METS min/week) across four visits (≈ 5 years) were summed to create an optimal lifestyle score. Carotid arterial stiffness was measured using distensibility coefficient (DC) and Young''s elastic modulus (YEM) at visit 1 and after a mean of 9.5 years (visit 5). The association of optimal lifestyle with 10‐year percent change in DC and YEM was assessed using multiple linear regression. DC decreased by 5.3% and YEM increased by 24.4% over 10 years. Mean optimal lifestyle score was 9.4 ± 3.1 (range: 0–16). Individuals in quintiles 2–5 of optimal lifestyle score compared to quintile 1 (with the least optimal lifestyle score) did not show slower deceleration of DC [Q2, −0.3% (95% CI: −6.0, 5.4); Q3, −0.01% (−4.5, 4.5); Q4, −0.6% (−5.2, 3.9); Q5, −0.4% (−5.3, 4.4)], trend p‐value = .82] or slower progression of YEM [Q2, 0.1% (−7.1, 7.3); Q3, −0.8% (−8.0, 6.5); Q4, 4.5% (−2.3, 11.3); Q5, −0.2% (−8.3, 7.9)], trend p‐value = .49] after adjusting for risk factors. The association remained non‐significant when stratified by categories of age, sex, race, BP control, and diabetes. Our findings indicate that optimal score on multiple health behaviors may not independently slow arterial stiffness progression.     

Three year continuous abstinence in a smoking cessation study using the nicotine transdermal patch

A total of 305 subjects from Sydney were randomly allocated to receive either an active (24 hour transdermal nicotine patch over a 10 week course) or placebo nicotine patch. All subjects participated in a multicomponent cognitive-behavioural smoking cessation programme over five weeks in two-hour group sessions. The continuous abstinence rates at three years (validated by expired carbon monoxide) were 13.8% for the active group and 5.2% for placebo group (p = 0.011). The active nicotine patch with behavioural therapy achieved more than double the abstinence rates early in treatment compared with placebo and this difference was maintained throughout the three year follow up.

Keywords: smoking cessation;  nicotine patches     

Predicting the life‐time benefit of school‐based smoking prevention programmes

Aim School‐based smoking prevention programmes may delay the age of smoking initiation, but do not appear to achieve lasting reductions in smoking prevalence beyond school‐leaving age. We explored whether delaying the age at which someone initiates smoking may have life‐time benefits by increasing the likelihood of quitting in later life. Design and setting Data from the General Household Survey of Great Britain were used in a logistic regression model to examine the association between age at which someone initiates regular smoking and the probability that the person will quit smoking later in life. The effect of confounding variables (sex, ethnicity, socio‐economic class, education and geographical location) was taken into account. The predicted relationship was used in a cohort model to estimate the life‐time reduction in smoking prevalence and all‐cause mortality of a school‐based smoking prevention programme. Results Age of regular smoking initiation was associated strongly with the probability of quitting later in life (coefficient ?0.103, P < 0.001). The strength of the association was slightly reduced but still significant when confounding variables were included (coefficient ?0.075, P < 0.001). An intervention that delays smoking initiation without decreasing smoking prevalence at age 18 may reduce adult smoking prevalence by 0.13–0.32% (depending on age) and all‐cause mortality by 0.09% over the life‐time of the sample. Conclusion School‐based smoking prevention programmes have potential for a beneficial effect over the life‐time of the participants even if they have no apparent effect at school‐leaving age.     

Cessation in the use of tobacco – pharmacologic and non‐pharmacologic routines in patients

Introduction: Approximately one‐third of the adult population in industrial countries and 70% in several Asian countries are daily smokers. Tobacco is now regarded as the world's leading cause of death. Approximately two‐thirds of lifelong smokers eventually die because of smoking. Smoking cessation is the most effective action to reduce mortality in patients with chronic obstructive pulmonary disease (COPD) and coronary heart disease. Objective: The aim of this study was to determine the effectiveness of smoking cessation programmes in patients with smoking‐related disorders. Methods: Medline was searched for studies of interventions for smoking cessation in patients. Results: In patients with cardiovascular diseases and COPD, smoking cessation programmes with behavioural support over several months significantly increase quit rates. The intensity of the programmes seems to be proportional to the effect. A long follow‐up period is probably the most important element in the programmes. Even the most intensive programmes are very cost‐effective in terms of cost per life‐year gained. Effective programmes can be delivered by personnel without special education in smoking cessation using simple intervention principles. Conclusions: In patients with smoking‐related disorders, smoking cessation interventions with several months of follow‐up are effective and easily applicable in clinical practice. Wider implementation of such programmes would be a cost‐effective way of saving lives. Please cite this paper as: Quist‐Paulsen P. Cessation in the use of tobacco – pharmacologic and non‐pharmacologic routines in patients. The Clinical Respiratory Journal 2008; 2: 4–10.     

Association of adolescent symptoms of depression and anxiety with daily smoking and nicotine dependence in young adulthood: findings from a 10‐year longitudinal study

Aims To examine the association of adolescent depression and anxiety symptoms with daily smoking and nicotine dependence in young adulthood. Design A prospective cohort study of adolescent and young adult health (n = 1943). Teen assessments occurred at 6‐monthly intervals, with two follow‐up assessments in young adulthood (wave 7, 1998; wave 8, 2001–03). Setting Victoria, Australia. Participants Students who participated at least once during the first six (adolescent) waves of the cohort study. Measurements Adolescent depression and anxiety symptoms were assessed using the Revised Clinical Interview Schedule (CIS‐R). Young adult tobacco use was defined as: daily use (6 or 7 days per week) and dependent use (≥4 on the Fagerstrom Test for Nicotine Dependence). Findings Among adolescent ‘less than daily’ smokers, those with high levels of depression and anxiety symptoms had an increased risk of reporting nicotine dependence in young adulthood [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.2–9.1] compared to young adults who had low levels of adolescent depression and anxiety symptoms, after adjusting for potential confounding factors. Similarly, in the adjusted model (OR 1.9, 95% CI 1.0–3.4), among adolescent ‘daily’ smokers, those with high levels of depression and anxiety symptoms had an almost two‐fold increase in the odds of reporting nicotine dependence in young adulthood compared to young adults with low levels of adolescent depression and anxiety symptoms. Conclusions Adolescent smokers with depression and anxiety symptoms are at increased risk for nicotine dependence into young adulthood. They warrant vigilance from primary care providers in relation to tobacco use well into adulthood.     

Assessment of factors associated with smoking cessation at diagnosis or during follow‐up of Crohn's disease

Background and Aim

Smoking cessation is known to improve the course of Crohn's disease (CD). However, the factors associated with smoking cessation after CD diagnosis have not been well established.

Methods

Clinical characteristics and change in smoking status were evaluated in 445 current smokers at the time of CD diagnosis. Patients were classified into three subgroups based on their final smoking status and time of smoking cessation: non‐quitters, quitters at diagnosis, and quitters during follow‐up.

Results

The overall smoking cessation rate was 55.7% (248 of 445 patients). The diagnosis of CD was the main reason for quitting (41.5%, 103 of 248 patients). Smoking cessation at the time of CD diagnosis was associated with intestinal resection within 3 months from CD diagnosis (odds ratio [OR] 2.355, 95% confidence interval [CI] 1.348–4.116, P = 0.003), light smoking (OR 2.041, 95% CI 1.157–3.602, P = 0.014), and initiation of smoking before 18 years of age (OR 0.570, 95% CI 0.327–0.994, P = 0.047). Light smoking (OR 1.762, 95% CI 1.019–3.144, P = 0.043) and initiation of smoking before 18 years (OR 0.588, 95% CI 0.381–0.908, P = 0.017) were also associated with overall smoking cessation.

Conclusion

Quitters after CD diagnosis, including quitters at diagnosis and quitters during follow‐up, had features distinct from those of non‐quitters. Given the motivation at CD diagnosis, a detailed history of smoking habits should be taken and all current smokers should be encouraged to quit smoking at the time of CD diagnosis.     

Startle cue–reactivity differentiates between light and heavy smokers

Aims   It was assumed that the startle amplitude in smokers is reduced while viewing pictures of smoking, suggesting that smoking cues are appetitive. The goal of the present study was to investigate (i) whether smoking scenes induce appetitive cue effects in smokers, and (ii) whether smoking intensity is related to cue–reactivity.
Design   Smokers and non-smokers participated in a single session.
Participants   A total of 62 individuals participated: 36 smokers and 26 non-smokers.
Measurements   Participants took part in an acoustic affective startle experiment using standardized pleasant, neutral and unpleasant scenes from the International Affective Picture System (IAPS), as well as pictures of smoking. The effect of smoking cues was assessed by comparing neutral and smoking scenes (termed cue-related startle suppression, CSS).
Findings   While there was no overall difference between smokers and non-smokers regarding the CSS, light smokers showed significantly increased cue–reactivity towards smoking-related cues, as compared with heavy smokers and non-smokers. In addition, light smokers also displayed stronger appetitive responses towards positive stimuli.
Conclusions   These data support recent theories which discriminate between habit-based and incentive-based drug abuse. This distinction may have consequences for the assessment and treatment of drug-addicted subjects. Furthermore, incentive-based light smoking seems to have general effects on the reward system.